Secondary massive cerebral infarction after removal of acute epidural hematoma:multivariate Logistic regression analysis of risk factors

Objective To analyze the risk factors for secondary massive cerebral infarction after open surgery for acute epidural hematoma( EDH) and provide clinical evidences for the decision of additional decompressive craniectomy. Methods Cohort included 176 EDH patients who underwent surgical hemotoma evacuation in Department of Neurosurgery,175th Hospital of PLA. Their clinical datas were studied retrospectively and the potential risk factors for postoperative massive cerebral infarction and brain edema were investigated by multivariate Logistic regression analysis. Results A total of 32 patients developed secondary massive cerebral infarction and brain edema. Statistical analysis revealed significant positive associations between MCI and location of EDH( odds ratio [OR] =16.48,P =0.003),occurrence of preoperative shock( OR =13. 78,P =0. 002),extent( OR =7. 08, P =0. 004) and duration( OR = 6. 41,P 0. 001) of preoperative brain hernia,volume of EDH( OR = 7. 04, P =0. 001),and Glasgow Coma Score( GCS)( OR =0. 35,P 0. 053). There was no significant association between MCI and age,drift of middle-line structure,occurrence of intraoperative hypotension,blood sodium level,and blood glucose level. Conclusion Patients with temporal hematoma 100 ml,preoperative shock for over 30 min,bilateral mydriasis,brain hernia for over 90 min before initial open surgery and lower GCS score had the increased risk of postoperative massive cerebral infarction and brain edema.