Abstract
Background
To study the role of conservative management and various reasons for conversion to surgical intervention in traumatic extradural hematoma (EDH).
Setting
Government Medical College Jammu.
Materials and methods
One hundred-twenty trauma patients diagnosed as extradural hematoma on CT scan were managed during 1 year period.
Outcomes
Role of conservative management and various reasons for conversion to surgical intervention were studied.
Results
Out of these 120 patients admitted 67 were managed conservatively, 53 cases were operated upon. 31 were operated upon immediately and 22 were operated upon as delayed. There was 1 death and 4 had poor outcome in this group of patients.
Conclusion
It is stressed that small size <10 ml, GCS >12 and locations other than temporal area are the criteria for conservative management. Twenty-two patients out of 89 were needed to be treated surgically during the course of conservative management due to neurodeterioration, increase in size of hematoma on CT, bradycardia, hemiparesis, pupillary abnormalities, delay in referral and only 18% had poor outcome. A strict vigilance is to be kept for clinical deterioration and various reasons mentioned above are to be kept in mind and patients should be subjected to repeated CT scan. Early diagnosis and immediate surgical intervention had good outcome, which shows the fruitful results of early diagnosis and intervention.
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References
Bell C (1816) Surgical observations. Longman, Hirst Rees Edv Arrie and Brown: 466
Frankhauser H, Kiener M (1982) Delayed development of extradural hematoma. Acta Neurochir (Wien) 60:29–35
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage, a practical scale. Lancet 1: 480–484
Hill J (1772) Case in surgery particularly of cancers and disorders of the head from external violence and observation. J Balfour, Edinburgh: 263
Munro D, Maltby GL (1941) Extradural hemorrhage. Ann Surg 113(2):192–203
Seeling JM, Marshal LF, Tautan SM, et al. (1984) Traumatic acute EDH, unrecognized lethality in comatosed patients. Neurosurg 15:617–620
Pozzati E, Frank F, Frank G, et al. (1980) Subacute and chronic EDH, A study of 30 cases. J Trauma 20(9):795–799.
Zuccarello M, Fiore DL, Pardatscher K, et al. (1983) Chronic EDH. Acta Neurochirurgica 67:57–66
Kaufman HH, Herschberger J, Kopitnik T, et al. (1992) Chronic EDH, Indications for surgery. Br J Neurosurg 6:359–364
Jamieson KG, Yelland J DN (1968) Extradural and subdural hematoma. Report of 167 cases. J Neurosurg 299:13–23
Aoki N (1981) Rapid resolution of acute epidural hematoma. Report of 2 cases. J Neurosurg 54:258–261
Tochio H, Waga S, Tashiro H, et al. (1984) Spontaneous resolution of chronic epidural hematomas. Report of 3 cases. Neurosurg 15:96–100
Illingworth R, Shawdon H (1983) Conservative management of intracranial extradural hematoma presenting late. J Neurol Neurosurg Psychiatry 46:558–560
Pang D, Horton JA, Henon JM, et al. (1989) Non-surgical management of extradural hematomas in children. J Neurosurg 59:958–971
Tuncer R, Kazan S, Ucar T, et al. (1993) Conservative management of epidural hematomas. Prospective study of 15 cases. Acta Neurochir (Wien) 121:48–52
Bullock R, Smith RM, Van Dellen JR (1985) Non-operative management of extradural hematoma. Neurosurg 16: 602–606
Ceylan S, Kuzeyli K, Ilbay K, et al. (1992) Non-operative management of acute extradural hematoma in children. J Neurosurg Sci 36:85–88
Chen TY, Wong CW, Chang CN, et al. (1993) The expectant treatment of asymptomatic supratentorial EDH. Neurosurg 32(2):176–179
Weaver D, Pofereskin L, Jane JA (1981) Spontaneous resolution of EDH. Report of two cases. J Neurosurg 54: 248–251
Trowbridge WV, Poster RW, French JD. (1954) Chronic EDH. Arch Surg 69:324–330
Tuncer R, Acikbas C, Ucar T, Kazan S, Karasoy M, Saveren M (1997) Conservative management of extradural haematoma. Effects of skull fractures on resorption rate. Acta Neurochirurgica 139(3):203–207
Cook RJ, Dorsch NW, Fearnside MR, et al. (1988) Outcome prediction in EDH. Actaneurochir (Wein) 95(3–4):90–94
Servadei F, Faccai G, Rocella P, et al. (1989) Asymptomatic EDH, results of a multicenter study of 158 cases in minor head injury. Acta Neurochir (Wein) 96:39–45
Bezircioglu H, Ersahin Y, Demircivi F, et al. (1996) Nonoperative treatment of acute extradural hematomas: analysis of 80 cases. J Trauma 41:696–698
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Bhau, K.S., Bhau, S.S., Dhar, S. et al. Traumatic extradural hematoma — role of non-surgical management and reasons for conversion. Indian J Surg 72, 124–129 (2010). https://doi.org/10.1007/s12262-010-0036-1
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DOI: https://doi.org/10.1007/s12262-010-0036-1