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Conservative management of significant supratentorial epidural hematomas in pediatric patients

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Abstract

Background

Radiologically significant epidural hematomas are generally treated with craniotomy and evacuation. However, pediatric patients with such hematomas may have normal neurological examinations. We aim to report the presenting features, management, and outcomes of pediatric patients who underwent conservative management of such hematomas at our center and also show that serial neurological examinations are a safe and effective way of managing these patients.

Methods

A retrospective review of pediatric patients with extradural hematoma (EDH) thickness of at least 1 cm and who were conservatively managed was performed. All patients were followed up in neurosurgery outpatient clinics after discharge at 1-month, 3-month, 6-month, and 1-year intervals. Detailed neurological examination was performed at each visit, and a standardized questionnaire was also used to document the parent’s subjective opinion of the patient’s quality of life.

Results

A total of 17 patients satisfied the study criteria and were included. Conservative management was successful in 15 patients, while a craniotomy with evacuation of hematoma had to be performed in two patients. All patients had a GOS score of 5 on 1-year follow-up, had normal schooling, and reported complete satisfaction with the management protocol.

Conclusion

Conservative treatment is an optimal treatment option, and patients can be followed safely using a protocol of serial neurological examinations. A center must have resources to perform a craniotomy with evacuation of EDH in case of neurological worsening and be able to provide trained staff to carry out serial neurological examinations before treating these patients conservatively.

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Abbreviations

EDH:

Extradural hematoma

ER:

Emergency room

GCS:

Glasgow Coma Scale

GOS:

Glasgow Outcome Score

ICP:

Intracranial pressure

PTSD:

Post traumatic stress disorder

RTA:

Road traffic accident

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Authors and Affiliations

  1. Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan

    Muhammad Babar Khan, Muhammad Riaz & Gohar Javed

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  1. Muhammad Babar Khan
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  2. Muhammad Riaz
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  3. Gohar Javed
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Correspondence to Gohar Javed.

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Khan, M.B., Riaz, M. & Javed, G. Conservative management of significant supratentorial epidural hematomas in pediatric patients. Childs Nerv Syst 30, 1249–1253 (2014). https://doi.org/10.1007/s00381-014-2391-x

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  • DOI: https://doi.org/10.1007/s00381-014-2391-x

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