Analysis of the Risk Factors for Intraoperative Acute Diffuse Brain Swelling in Patients With Isolated Traumatic Acute Subdural Haematomas

Background: The purpose of this retrospective study was to investigate the risk factors for intraoperative acute diffuse brain swelling in patients with isolated traumatic acute subdural haematomas (ASDH). Methods: : A total of 256 patients who underwent decompressive craniotomy for isolated traumatic ASDH between April 2013 and December 2020 were included. We evaluated the risk factors for intraoperative acute diffuse brain swelling using a multivariate logistic regression analysis. Results: : The incidence of intraoperative acute diffuse brain swelling in patients with isolated traumatic ASDH was 21.88% (56/256). Dilated pupils (OR=24.78), subarachnoid haemorrhage (OR=2.41), and the time from injury to surgery (OR=0.32) were independent predictors of the risk factors for intraoperative acute diffuse brain swelling, while no independent associations were observed between the risk factors and sex, age, the Glasgow Coma Scale score, site of haematoma, thickness of haematoma, midline shift and the status of the basal cistern, although the Glasgow Coma Scale score and the status of the basal cistern were correlated with the incidence of intraoperative acute diffuse brain swelling in the univariate analyses. Conclusions: : This study identified the risk factors for intraoperative acute diffuse brain swelling in patients with isolated traumatic ASDH. An increased risk of intraoperative acute diffuse brain swelling occurs in patients with bilaterally dilated pupils, subarachnoid haemorrhage and a shorter time from injury to surgery. These findings should help neurosurgeons obtain information before surgery about the intraoperative acute diffuse brain swelling in patients with isolated traumatic ASDH.