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Our experience in diagnosing and surgical treatment of traumatic intracranial hematomas. Analysis of 610 patients.

610 patients with traumatic intracranial hematomas treated in the Clinic of Neurosurgery in Plovdiv University of Medicine from 1975 to 1990 were studied. The study aimed at analyzing the most common clinical symptoms and paraclinical indicators leading to correct diagnosis and showing the possibilities of approximate determination of the hematoma location in accordance with the shift of the brain midline and the trauma biomechanics. It also recommends the most effective surgical method which yields the least number of hematoma recurrences. In the study the most common clinical symptom is shown to be the lucid interval. The most common paraclinical indicator is the shift of the brain midline caused by the pathological process. Visualization of the brain midline used in conjunction with the data from the biomechanics of the injury could guide the surgeons for the first burr hole in the exploratory trephination of the skull. It is recommended that, if possible, osteoplastic trephination of the skull on a four-burr-hole bone flap should be applied in the acute period of the craniocerebral trauma. This surgical method assures achievement of the best hemostasis, complete evacuation of the hematoma and the least percentage of recurrences of hematoma after surgery.