Reperfusion injury following surgical evacuation of epidural hematoma in patients with cerebral herniation / 中华神经医学杂志

ABSTRACT

Objective To investigate the clinical characteristics and risk factors of intra- and post-operative reperfusion injury following surgical evacuation of epidural hematoma. Methods Clinical and radiographic data of 206 patients with cerebral herniation presented with an epidural hematoma and underwent surgical evacuation in our hospital from June 2009 to June 2015, were retrospectively analyzed; risk factors of intra- and post-operative reperfusion injury were analyzed by multi-factor and non-conditional Logistic regression analyses. Results A total of 12 patients with acute epidural hematoma and concurrent cerebral herniation developed reperfusion injury after hematoma evacuation; 7 patients (58.3%) were within 15-30 min after surgical evacuation intraoperatively and 5 patients (41.7%) were at an early stage within 6 h after operation. Local vascular cerebral edema, effusion, or even spot and patchy hemorrhage in the compressed cerebral parenchyma underneath the epidural hematoma were depicted by craniocerebral CT/MR imaging examination and further CT perfusion examination confirmed the local hyperperfusion-induced lesions. These 12 patients had an unsatisfactory clinical outcome with a high ratio of bad prognosis (58.3%, 7/12). Regression analyses indicated that the described surgical complication was significantly associated with duration of preoperative cerebral herniation (≥120 min, odds ratio [OR]=61.617, P=0.001), hematoma thickness (≥40 mm, OR=10.051, P=0.018). Conclusions Cerebral herniation longer than 120 min and hematoma thickness greater than 40 mm are high-risk factors associated with intra- and post-operative reperfusion injury. Controlled decompressive surgical strategy is helpful for a good recovery of cerebrovascular autoregulation function and thereby reduces the occurrence of reperfusion injury.