• Baynazir Khan Ayub Medical Institute
  • Ehtisham Ahmed Khan Afridi Ayub Medical Institute, Abbottabad
  • Bushra Khan Ayub Medical Institute, Abbottabad
  • Shahbaz Ali Khan Ayub Medical Institue, Abbottabad
  • Ahsan Aurangzeb
  • Abdul Aziz Khan
  • Wajiha Khan COMSATS Institute Abbottabad
  • Sajid Nazir Bhatti


Background: Traumatic subdural hematoma is one of the lethal injuries to brain. Various surgical techniques are used to evacuate the acute subdural hematoma. The hematoma evacuation can either be done by opening of dura by multiple slits or by opening of dura in single large c shape and then doing the expansile duraplasty. Present study aimed to compare both these techniques. Methods: This randomized control study was conducted in department of neurosurgery, Ayub Medical College, Abbottabad from July 2011 to July 2013. A total of 59 patients were included in this study, which were randomly allocated in two groups (i.e., group A and group B) for decompressive craniectomy. Thirty-one patients were operated by craniectomy with full dural flap opening (Group A), and 28 patients were operated by craniectomy with multidural-slits (Group B). Glasgow Outcome score (GOS) at 6 weeks after the surgery was used to determine the outcome. Results: Mean age of the patients was 33.4±12.8 years. Majority were males. In group A 51.6 % (16) of the patients survived out of which a favourable outcome (GOC 3-5) was observed in 41.9% of the patients, and 9.1% of patients ended up in vegetative state. While in group B 46.4% (13) of the patients survived among which favourable outcome was seen in 39.3% of patients and 7.1% of patients ended up in vegetative state. The difference in outcome measure is insignificant. Conclusion: There was no statistically significant difference among the two groups as regards the mortality, GOS, frequency of complications and hospital. While the duration of surgery was significantly shorter in patients operated with dural slits.Keywords: acute subdural hematoma, decompressive craniectomy, multidural-slits

Author Biography

Baynazir Khan, Ayub Medical Institute

Senior Registrar, Department of Neurosurgery, Ayub Medical Institute. Abbottabad.


Cosar M, Eser O, Aslan A, Ela Y. Rapid resolution of acute sub-dural hematoma and effects on the size of existent sub-dural hygromas: A case report. Turk Neurosurg 2007;17(3):224–7.

Vilela M, West GA. Traumatic Intracranial Hematomas. In; Rengachary SS, Ellenbogen RG. edi. Principles of Neurosurgery. 2nd ed. USA; Elsevier 2005;361–2.

Felciano CE, De Jesus O. Conservative management outcomes of traumatic acute sub-dural hematomas. P R Health Sci J 2008;27(3):220–3.

Taussky P, Widmer HR, Takala J, Fandino J. Outcome after acute traumatic sub-dural and epidural haematoma in Switzerland: a single-centre experience. Swiss Med Wkly 2008;138(19-20):281–5.

Chabok SY, Safaie M, Moghadam AD, Behzadnia H, KhaliliRad M, Larimi SR. Acute subdural hematoma: A comparative study of 2 types of operative techniques. Neurosurg Q 2011;21(2):103–6.

Yanagawa Y, Sakamoto T. Results of single burr-hole drainage for acute sub-dural hematoma with non-reactive pupil. Turk Neurosurg 2012;22(2):196–9.

Bhat AR, Wani MA, Kirmani AR. Acute sub-dural hematoma with severe traumatic brain edema evacuated by Dural-Stabs- A new brain preserving technique. Biomed Res 2010;21(2):167–73.

Wani AA, Dar TI, Ramzan AU, Malik NK, Kirmani AR, Bhatt AR, et al . Decompressive Craniectomy in head injury. Indian J Neurotrauma 2009;6(2):103–10.

Sawauchi S, Marmarou A, Beaumont A, Signorett S, Fukui S. Acute Sub-dural Hematoma associated with diffuse brain injury and hypoxemia in the Rat: Effect of surgical evacuation of the hematoma. J Neurotrauma 2004;21(5):563–73.

Faleiro RM, Faleiro LC, Caetano E, Gomide I, Pita C, Coelho G, et al . Decompressive Craniectomy: prognostic factors and complications in 89 patients. Arq Neuropsiquiatr 2008;66(2B):369–73.

Koc RK, Akdemir H, Oktem IS, Meral M, Menku A. Acute sub-dural hematoma: outcome and outcome prediction. Neurosurg Rev 1997;20(4):239–44.



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