Advertisement

Child's Nervous System

, Volume 35, Issue 5, pp 807–813 | Cite as

Surgical management of traumatic extradural hematomas in children: an analysis of 201 patients at a tertiary neurosurgical center

  • Sandeep Kandregula
  • Nishanth SadashivaEmail author
  • Subhas Konar
  • Kannepalli Narasingha Rao
  • Dhaval Shukla
  • Dhananjaya Bhat
  • Bhagavatula Indira Devi
Original Article

Abstract

Introduction

The effects of traumatic extradural hematoma (EDH) are potentially reversible if treated early. Pediatric EDH differs from its adult counterpart because of the differential elastic and adherence properties of skull bone and dura respectively. There is a paucity of literature regarding prognosis and factors predicting the outcome of pediatric EDH. In this study, we aimed to study the factors predicting outcome and prognosis of traumatic EDH in the pediatric age group.

Materials and methods

We did a retrospective chart review of all pediatric EDH operated in our center between 2011 and 2017. Factors affecting prognosis were analyzed through univariate and multivariate analyses.

Results

Two hundred one patients qualified for the study. There were 159 boys and 42 girls with a sex ratio of 3.78:1. The most common modes of injury were road traffic accidents (n = 108, 53.3%) followed by falls from a height. The most common clinical presentation was vomiting (n = 168, 83.3%), followed by headache (n = 72, 35.8%). Pupillary asymmetry was present in 11.4% (n = 23) patients. The mean GCS at presentation was 12.71. The mean volume of EDH was 37.18 cc, with a mean maximum thickness of 23.19 mm. The most common location of the EDH was at temporoparietal region (n = 67, 33.3%). The median time of diagnosis from injury was 14.69 h (SD, 32.9 h). The mean GCS at discharge was 14.43 (SD ± 0.51). Sixteen patients were lost to follow; 185 patients were available for follow-up and were included in the outcome analysis. The mean GOS at follow-up was 4.9 (SD ± 0.368) with a median follow-up of 13.46 months. In our cohort, only one child died. Univariate and multivariate analyses revealed that pupillary asymmetry, pyramidal signs, low GCS at presentation, associated parenchymal injuries, and post-operative complications correlated negatively with outcome, whereas vomiting correlated positively with outcome.

Conclusion

Pediatric EDH differs from adults in complications as well as outcome. EDH in this pediatric cohort had a better outcome with very less mortality. Increased transportation facilities and the industrial revolution may have facilitated the shift of mode of injury from fall of height in the past to road traffic accidents in this study. A large study comparing the outcomes with pediatric and adult patients is warranted.

Keywords

Extradural hematoma Pediatric head injury Glasgow coma scale Glasgow outcome score 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW et al (2006) Surgical management of acute epidural hematomas. Neurosurgery 58(3 Suppl):S7–S15 discussion Si-ivGoogle Scholar
  2. 2.
    Choux M (1986) Extracerebral hematomas in children. Extracerebral Collections: Springer, p 173–208Google Scholar
  3. 3.
    Zhong W, Sima X, Huang S, Chen H, Cai B, Sun H, Hu Y, Liu Y, You C (2013) Traumatic extradural hematoma in childhood. Childs Nerv Syst 29(4):635–641CrossRefGoogle Scholar
  4. 4.
    Jamieson KG, Yelland JD (1968) Extradural hematoma. Report of 167 cases. J Neurosurg 29(1):13–23CrossRefGoogle Scholar
  5. 5.
    Mohanty A, Kolluri VR, Subbakrishna DK, Satish S, Mouli BA, Das BS (1995) Prognosis of extradural haematomas in children. Pediatr Neurosurg 23(2):57–63CrossRefGoogle Scholar
  6. 6.
    Munivenkatappa A, Deepika A, Prathyusha V, Devi I, Shukla DJ (2013) Can an abnormal CT scan be predicted from common symptoms after mild head injury in children. J Pediatr Neurosci 8(3):183Google Scholar
  7. 7.
    Mazza C, Pasqualin A, Feriotti G, Da Pian R (1982) Traumatic extradural haematomas in children: experience with 62 cases. Acta Neurochir 65(1–2):67–80CrossRefGoogle Scholar
  8. 8.
    dos Santos AL, Plese JP, Ciquini Junior O, Shu EB, Manreza LA, Marino Junior R (1994) Extradural hematomas in children. Pediatr Neurosurg 21(1):50–54CrossRefGoogle Scholar
  9. 9.
    Pasaoglu A, Orhon C, Koc K, Selcuklu A, Akdemir H, Uzunoglu H (1990) Traumatic extradural haematomas in pediatric age group. Acta Neurochir 106(3–4):136–139CrossRefGoogle Scholar
  10. 10.
    Erşahin Y, Mutluer S, Güzelbag E (1993) Extradural hematoma: analysis of 146 cases. Childs Nerv Syst 9(2):96–99CrossRefGoogle Scholar
  11. 11.
    Kuday C, Uzan M, Hanci M (1994) Statistical analysis of the factors affecting the outcome of extradural haematomas: 115 cases. Acta Neurochir 131(3–4):203–206CrossRefGoogle Scholar
  12. 12.
    Herrera EJ, Viano JC, Aznar IL, Suarez JC (2000) Postraumatic intracranial hematomas in infancy. A 16-year experience. Childs Nerv Syst 16(9):585–589CrossRefGoogle Scholar
  13. 13.
    Ciurea AV, Kapsalaki EZ, Coman TC, Roberts JL, Robinson JS 3rd, Tascu A et al (2007) Supratentorial epidural hematoma of traumatic etiology in infants. Childs Nerv Syst 23(3):335–341CrossRefGoogle Scholar
  14. 14.
    Erşahin Y (2010) Extradural haematomas in children. Br J Neurosurg 24(4):503CrossRefGoogle Scholar
  15. 15.
    Chowdhury SN, Islam KM, Mahmood E, Hossain SK (2012) Extradural haematoma in children: surgical experiences and prospective analysis of 170 cases. Turk Neurosurg 22(1):39–43Google Scholar
  16. 16.
    Huisman T, Tschirch FT (2009) Epidural hematoma in children: do cranial sutures act as a barrier. J Neuroradiol 36(2):93–97Google Scholar
  17. 17.
    Dhellemmes P, Lejeune JP, Christiaens JL, Combelles G (1985) Traumatic extradural hematomas in infancy and childhood. Experience with 144 cases. J Neurosurg 62(6):861–864CrossRefGoogle Scholar
  18. 18.
    Choux M, Grisoli F, Peragut JC (1975) Extradural hematomas in children. 104 cases. Childs Brain 1(6):337–347Google Scholar
  19. 19.
    Raimondi AJ, Hirschauer J (1984) Head injury in the infant and toddler. Coma scoring and outcome scale. Childs Brain 11(1):12–35Google Scholar
  20. 20.
    Berger MS, Pitts LH, Lovely M, Edwards MS, Bartkowski HM (1985) Outcome from severe head injury in children and adolescents. J Neurosurg 62(2):194–199CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryNational Institute of Mental Health and Neuro Sciences(NIMHANS)BangaloreIndia

Personalised recommendations