Reoperations after surgery for acute subdural hematoma: reasons, risk factors, and effects.

PURPOSE: To analyze the reasons and patient-related and injury-related risk factors for reoperation after surgery for acute subdural hematoma (SDH) and the effects of reoperation on treatment outcome. METHODS: Among adult patients operated on for acute SDH between 2013 and 2017, patients reoperated within 14 days after the primary surgery were identified. In all patients, parameters were identified that related to the patient (age, anticoagulation, antiplatelet, and antiepileptic treatment, and alcohol intoxication), trauma (Glasgow Coma Score, SDH thickness, midline shift, midline shift /hematoma thickness rate, other surgical lesion, primary surgery-trephination, craniotomy, or decompressive craniotomy), and Glasgow Outcome Score (GOS). The reasons for reoperation and intervals between primary surgery and reoperation were studied. RESULTS: Of 86 investigated patients, 24 patients were reoperated (27.9%), with a median interval of 2 days between primary surgery and reoperation. No significant differences in patients and injury-related factors were found between reoperated and non-reoperated patients. The rate of primary craniectomies was higher in non-reoperated patients (P = 0.066). The main indications for reoperation were recurrent /significant residual SDH (10 patients), contralateral SDH (5 patients), and expansive intracerebral hematoma or contusion (5 patients). The final median GOS was 3 in non-reoperated and 1.5 in reoperated patients, with good outcomes in 41.2% of non-reoperated and 16.7% of reoperated patients. CONCLUSIONS: Reoperation after acute SDH surgery is associated with a significantly worse prognosis. Recurrent /significant residual SDH and contralateral SDH are the most frequently found reasons for reoperation. None of the analyzed parameters were significant reoperation predictors.

Sex and ancestry related differences between two Central European populations determined using exocranial meshes.

Assessing sex and population affinity is an important part of the process of biologically identifying unknown human remains, and the skull is usually one of the best structures for assessing both these components of the biological profile. Population affinity is known to be a hugely important variable when estimating sex because the manifestation of sexually dimorphic traits, body size or social and behavioural habits differs across populations. Therefore, for forensic purposes, the estimation of ancestry is a necessary step in the identification of bone remains. The present study improves on the results of a previously developed virtual method using the exocranial surface for sex estimation and assessing population affinity. The ability to assess these components of the biological profile was successfully tested on 208 individuals from two recent European populations. The original classifier was based on geometric morphometric analyses (CPD-DCA, PCA, SVM) and was able to assess the sex of individuals belonging to one French population with an accuracy exceeding 90 % Musilová et al. [1]. To improve the reliability of the method, the Czech population sample was added to the dataset, yielding the highest accuracy of 96.2 %; using the combined dataset, the reliability of the method was 91.8 %. Secondly, we used the same method utilizing inter-population differences to classify individuals based on the shape of the skull. The greatest accuracy rate was 92.8 %, which makes our method a promising tool for sex estimation and assessing population affinity.

Exocranial surfaces for sex assessment of the human cranium.

Determination of sex is one of the most important and challenging disciplines in biological anthropology. Creating a robust tool for sexing crania is crucial for forensic anthropology, especially in this period of migration, travel, and globalization, when different populations are mixed together in one region. Many different approaches to sex estimation using the skull have been published; however, population specificity and oscillation of variable sexual dimorphism typically reduces their effectiveness. The aim of this study was to create a robust classifier using virtual anthropology without the use of a CT scanner. The entire cranial surface was analyzed using coherent point drift-dense correspondence analysis and classification was performed using a support vector machine with a radial kernel, minimizing subjective error. The study sample consisted of 103 CT scans of a recent southern French population. Virtual scans of 52 males and 51 females (age from 18 to 92) were analyzed using 3D software systems (Rapidform, Avizo, Morphome3cs) and innovative approaches in geometric morphometrics. Leave-one-out crossvalidation was also applied. Sex differences in shape and form were displayed by colour scale maps. The whole cranial surface was significantly different between males and females in size (form). Sexual dimorphism was significantly lower in senile skulls. The most exclusive areas were the supraorbital region, orbits, cheek bones, nasal apertures, mastoids, and external occipital protuberances. The method provided a high level of classification accuracy (90.3%) in sexing male and female skulls and is a valuable tool for sex determination.