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Hemicraniectomy for acute extracerebral hematoma: an analysis of clinical and radiographic findings

Robert A. Morantz, Raul M. Abad, Ajax E. George, and Richard L. Rovit

✓ The authors report their experience with hemicraniectomy for acute subdural or epidural hematomas in 75 patients, 18 of whom had postoperative contrast studies and/or RISA cisternograms at intervals from 1 day to 1½ years after operation. Analysis of these studies reveals: 1) Hemicraniectomy virtually eliminates the incidence of residual and recurrent postoperative hematoma. 2) Shifted midline structures may often take up to several weeks to return to normal position after operation. Return of these shifted structures may be hastened by hemicraniectomy, as compared to more restricted operations. 3) There is a general, but not absolute, correlation between the degree of postoperative shift and the clinical status of the patient. 4) An ipsilateral shift has been observed only in the presence of a mass on the opposite side or severe hydrocephalus. 5) Pneumoventriculography after hemicraniectomy usually demonstrates slight ventricular dilatation, most marked in the ipsilateral ventricle. A small percentage (16%) of postoperative patients reveal severe communicating hydrocephalus.