Características do Hematoma Epidural Contralateral após Craniectomia Descompressiva para Tratamento de Trauma Cranioencefálico Grave. Revisão Sistemática

Introduction: Decompressive craniectomy is considered the most used surgical method in the treatment of refractory intracranial hypertension due to severe brain injury. Despite being described as an effective method if correctly indicated, it can present severe early complications, among them the contralateral epidural hematoma. Objective: The aim of this study is to evaluate the main characteristics for the development of contralateral epidural hematoma, promoting the recognition and prevention of the complication. Methodology: This is a systematic review with no meta-analysis, performed by the Pubmed and Scielo databases. Results: Sixty-seven patients were found by contralateral epidural hematoma after decompressive craniectomy. The suspicion of new bleeding was observed by the pupillary abnormality (22.3%), increased intracranial pressure (18%), brain swelling (22.3%), or when accused by routine tomography (26.8%). At least 86.36% of the patients presented contralateral skull fracture to the initial hematoma. Conclusion: The incidence of contralateral hematoma following decompressive craniectomy for traumatic brain injury was 5.2%. A contralateral skull fracture is the main characteristic for contralateral epidural hematoma development. Unexplained brain swelling or the presence of pupillary abnormalities in the postoperative period stand out as good indicator of contralateral hematoma development. However, neurological deterioration and the presence of coagulopathies are not reliable indicators of contralateral epidural hematoma after decompressive craniectomy.