Urgent bilateral craniotomies for the patients with severe head injury

The present study analyzed 11 patients who required urgent alternative bilateral craniotomies for intracranial hematomas from among 195 patients who underwent emergency craniotomy in our institution from January 1995 to January 2004. Mean age of the patients undergoing the urgent bilateral craniotomies was 30.8 years (range, 16-56 years) with a male preponderance (male:female, 10:1). Overall frequency of bilateral craniotomies was 5.6% among emergency craniotomies. Cause of injury was traffic accident in 9 patients and falls in the other 2 patients. Preoperative Glasgow coma scale was 3-8 in 7 patients, 9-12 in 2 patients and 13-15 in 2 patients. In terms of the hematoma combination, acute subdural hematoma (ASDH) following contralateral acute epidural (AEDH) was most frequent occurring in 6 patients, with AEDH following AEDH in 2 patients, AEDH following ASDH in 2 patients, and ASDH following ASDH in 1 patient. Skull fractures associated with AEDH were seen in all patients except the patient with ASDH following ASDH. All patients underwent urgent hematoma evacuation and good outcomes were obtained in 3 patients who were < 30-years-old with a GCS ≥ 10 on arrival to the emergency room. Early diagnosis and urgent craniotomy are indispensable in treating unilateral hematoma following contralateral hematoma, particularly in patients with ASDH associated with contralateral skull fracture.