PDF herunterladen
CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0044-1795164
Original Article

Clinical and Radiological Criteria for Surgery in Posttraumatic Extradural Hematoma: An Update from Central India

Ela Haider Rizvi
1   Department of Surgery, Era’s Lucknow Medical College, Lucknow, Uttar Pradesh, India
,
Snehil Sharma
1   Department of Surgery, Era’s Lucknow Medical College, Lucknow, Uttar Pradesh, India
,
Mohammad Kashif
1   Department of Surgery, Era’s Lucknow Medical College, Lucknow, Uttar Pradesh, India
,
Suramya Maheshwari
1   Department of Surgery, Era’s Lucknow Medical College, Lucknow, Uttar Pradesh, India
,
Ravi Pratap Singh
2   Department of Trauma & Emergency Medicine All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Atul Kumar Khare 
3   Department of Pediatrics Surgery, SMS Medical College, Jaipur, Rajasthan, India
› Institutsangaben Funding None.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Background The surgical management guidelines for any intracranial hemorrhage were objectively defined by the Brain Trauma Foundation (BTF) in 2006 for patients who should be treated surgically or conservatively. Since then, not much work has been done toward the identification of patients who are at high risk and may have progression of the hematoma who may ultimately require surgery. This study aimed to apply the said criteria to all patients coming to the hospital with extradural hematoma (EDH) and analyze the outcome of the patient whether treated conservatively or surgically on the basis of the Glasgow Outcome Scale (GOS) and to observe the factors and variables that are associated with EDH that will help in furthering the demographic design of the entity in central India.

Materials and Methods A prospective and retrospective, ambivalent cohort study was performed at a hospital in central India involving all cases of computed tomography (CT) diagnosed EDH that were reported to the center from October 2016 to March 2018. A total of 78 patients were included in the study. Patients were selected and managed conservatively or surgically as per the criteria and were followed up until the outcome. In retrospective analysis, we evaluated the current criteria for surgery in all patients of posttraumatic EDH in the past 5 years and whose records were available. Condition on discharge or the outcome along with GOS was taken as the endpoint for retrospective analysis.

Results Temporoparietal and frontal regions were the most common sites of EDH and also presented higher mortality rates as compared with other sites. The majority of patients had EDH of length of greater than 5 cm and the mortality rate for the same group also increased with lesser survival chances with length of greater than 10 cm. Patients who presented with an EDH of greater than 1-cm width were higher in numbers, with survival rates decreasing with an increase in width, especially with an EDH greater than 2 cm.

Conclusion We conclude that the criteria laid out by the BTF, namely, CT findings of an EDH volume greater than 30 mL, width greater than 15 mm, and mildline shift of greater than 5 mm, hold good in cases of EDH. This study reviewed the previous criteria in the Indian setting and found them to hold good so far.

Keywords

burr hole - complications - extradural hemorrhage - head trauma - traumatic brain injury


Publikationsverlauf

Artikel online veröffentlicht:
06. Dezember 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006; 21 (05) 375-378
    CrossrefPubMedSuche in Google Scholar
  • 2 Maugeri R, Anderson DG, Graziano F, Meccio F, Visocchi M, Iacopino DG. Conservative vs. surgical management of post-traumatic epidural hematoma: a case and review of literature. Am J Case Rep 2015; 16: 811-817
    CrossrefPubMedSuche in Google Scholar
  • 3 Babu ML, Kumar Bhasin S, Kumar A. Extradural hematoma: an experience of 300 cases. JK Science 2005; 7 (05) 205-207
    Suche in Google Scholar
  • 4 Lobato RD, Rivas JJ, Cordobes F. et al. Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg 1988; 68 (01) 48-57
    CrossrefPubMedSuche in Google Scholar
  • 5 Bullock MR, Chesnut R, Ghajar J. et al; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of acute epidural hematomas. Neurosurgery 2006; 58 (03) S7-S15 , discussionSi-iv
    PubMedSuche in Google Scholar
  • 6 Chen H, Guo Y, Chen S-W. et al. Progressive epidural hematoma in patients with head trauma: incidence, outcome, and risk factors. Emerg Med Int 2012; 2012: 134905
    CrossrefPubMedSuche in Google Scholar
  • 7 Offner PJ, Pham B, Hawkes A. Nonoperative management of acute epidural hematomas: a “no-brainer.”. Am J Surg 2006; 192 (06) 801-805
    CrossrefPubMedSuche in Google Scholar
  • 8 Khairat A, Waseem M. Epidural Hematoma. Treasure Island, FL:: StatPearls Publishing;; 2023
    Suche in Google Scholar
  • 9 Tataranu L, Ciubotaru V, Paunescu D, Spatariu A, Rădoi P. Extradural hematoma: is surgery always mandatory?. Rev Med Leg 2014; 22: 45-50
    Suche in Google Scholar
  • 10 Bullock MR, Chesnut R, Ghajar J. et al; Surgical management of acute epidural hematomas. Neurosurgery 2006; 58 (3 Suppl) S7-15 ; discussion Si-iv
    PubMedSuche in Google Scholar
  • 11 Soon WC, Marcus H, Wilson M. Traumatic acute extradural haematoma: indications for surgery revisited. Br J Neurosurg 2016; 30 (02) 233-234
    CrossrefPubMedSuche in Google Scholar
  • 12 Basamh M, Robert A, Lamoureux J, Saluja RS, Marcoux J. Epidural hematoma treated conservatively: when to expect the worst. Can J Neurol Sci 2016; 43 (01) 74-81
    CrossrefPubMedSuche in Google Scholar
  • 13 Zwayed ARH, Lucke-Wold B. Conservative management of extradural hematoma: a report of sixty-two cases. Neurol Clin Neurosci 2018; 2 (02) 5-9
    PubMedSuche in Google Scholar
  • 14 Gupta A, Saxena AK, Saxena A, Kumar C, Gupta A. Extradural haematoma: protocol needs revision for conservative management. Int Arch Biomed Clin Res 2017; 3 (04) 70-74
    Suche in Google Scholar