Influencing factors of expanding regional brain injury in patients with acute traumatic epidural hematoma after surgical evacuation

Objective To investigate the risk factors, mechanism and treatment strategies of expanding regional brain injury (traumatic intracerebral contusion or hematoma) in patients with acute traumatic epidural hematoma (ATEDH) after surgical evacuation. Methods Fifty-nine patients with ATEDH, admitted to and accepted surgical evacuation in our hospital from February 2013 to September 2018, were chosen in this study; their clinical data and CT imaging data were retrospectively analyzed. The volume of intracranial hematoma was measured by 3D Slicer software. According to the progress of local brain injury revealed by first CT examination after surgical evacuation, patients with ATEDH were divided into progressive group and non-progressive group. Risk factors of patients with expanding regional brain injury after surgery were analyzed by univariate and multivariate Logistic regression analyses. Results After surgery, 22 showed expanding regional brain injury, accounting for 37.29%: 9 occurred expanding intracerebral hematoma, and 2 of them died after conservative treatment; two had both expanding intracerebral contusion and hematoma; 11 expanding intracerebral contusion patients developed into hematoma, and three of them occurred delayed intracerebral hematoma adjacent to the area of ATEDH, and two underwent secondary craniotomy with good recovery. As compared with patients from the non-progressive group, progressive group had significantly higher percentages of patients with preoperative hyperglycemia (>9.1 mmol/L), patients with preoperative abnormal coagulation and patients accepted decompressive craniectomy (P<0.05). Multivariate Logistic regression analysis revealed that preoperative abnormal coagulation was an independent risk factor for expanding intracerebral contusion or hematoma after surgery (OR=6.498, 95%CI: 1.076-39.253, P=0.041). Conclusion Expanding regional brain injury has high morbidity in patients with ATEDH after surgery evacuation; preoperative abnormal coagulation is an independent risk factor for its occurrence. Key words: Acute traumatic epidural hematoma; Intracerebral contusion; Intracerebral hematoma; Risk factor; Treatment strategy