SURGICAL MANAGEMENT AND OUTCOMES OF MULTIPLE TRAUMATIC INTRACRANIAL HEMATOMAS IN SEVERE TRAUMATIC BRAIN INJURY

Abstract

Background. Multiple traumatic intracranial hematomas represent one of the most severe complications of traumatic brain injury and are associated with high mortality rates. Despite advances in neuroimaging and neurosurgical techniques, optimal surgical strategies for this pathology remain controversial.

Objective. To analyze the outcomes of intensive care and surgical treatment in patients with severe traumatic brain injury caused by multiple traumatic intracranial hematomas.

Materials and Methods. A retrospective analysis of 103 patients with multiple traumatic intracranial hematomas was performed. Clinical status, hematoma localization and combinations, surgical approaches (resection craniotomy, osteoplastic craniotomy, and enlarged burr holes), and treatment outcomes were evaluated.

Results. The most common combinations were subdural–subdural and subdural–epidural hematomas. Resection craniotomy was the predominant surgical approach, particularly in patients admitted in severe or extremely severe condition. Postoperative mortality reached 62.1% and was strongly associated with the depth of impaired consciousness and the severity of primary brain injury.

Conclusion. Early and adequate surgical intervention remains the cornerstone of management for multiple traumatic intracranial hematomas. Surgical strategy should be individualized based on patient condition, hematoma characteristics, and the degree of brainstem involvement.