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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2024; 43(04): e308-e314
DOI: 10.1055/s-0044-1796652
Review Article

Treatment Options for Intracranial Epidural Hematoma - An Integrative Review of the Past Three Decades

Opções de tratamento para hematoma epidural intracraniano - Uma revisão integrativa das últimas três décadas
Carlos Umberto Pereira 
1   Neurosurgery Service, Hospital de Urgências de Sergipe (HUSE), Aracaju, SE, Brazil
,
Lauro Roberto de Azevedo Setton 
2   Otorhinolaryngology Service, Hospital Santo Antônio Obras Irmã Dulce, Salvador, BA, Brazil
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Abstract

Introduction Acute epidural intracranial hematoma (IEH) has been considered one of the most relevant neurosurgical emergencies in recent decades due to its high potential for morbidity and mortality. Early diagnosis followed by appropriate treatment results in a more favorable prognosis considering its rapid progression.

Objective To describe the various treatment modalities for IEH in the last three decades and their updates.

Methods Integrative literature review on therapeutic options in IEH treatment. The terms “Epidural hematoma,” “Traumatic brain injury,” and “treatment” were used in the Medline/PubMed, Google Scholar, and SciELO platforms, resulting in 90 articles.

Results Appropriate treatment for IEH depends directly on the Glasgow Coma Scale score obtained during admission, bleeding location, lesion size, presence of associated intracranial injuries, and the neurosurgeon's experience.

Conclusion Initial treatment for IEH is predominantly surgical, with conservative treatment indicated in selected cases. Both neurosurgeons and clinicians must identify characteristic signs and symptoms promptly to avoid treatment delay. Moreover, minimally invasive approaches have gained prominence in recent decades, associated with image-guided procedures, and when well-indicated, result in rapid recovery and lower morbidity.

Resumo

Introdução O hematoma epidural intracraniano agudo (HEIA) tem sido considerado uma das emergências neurocirúrgicas de maior relevância das últimas décadas devido ao seu alto potencial de morbimortalidade. O diagnóstico precoce seguido de tratamento adequado resulta em prognóstico mais favorável, tendo em vista sua progressão galopante.

Objetivo Descrever as diversas modalidades de tratamento do HEIA nas últimas três décadas e suas atualizações.

Métodos Revisão integrativa de literatura sobre as opções terapêuticas no tratamento do HEIA. Foram utilizados os termos: “Hematoma epidural”, “Traumatismo cranioencefálico” e “tratamento” nas plataformas Medline/PubMed, Google Scholar e SciELO, resultando em 90 artigos.

Resultados O tratamento adequado para o HEIA, depende diretamente do escore na escala de coma de Glasgow obtido durante a admissão, localização do sangramento, tamanho da lesão, presença de lesões intracranianas associadas e da experiência do neurocirurgião.

Conclusão O tratamento inicial para o HEIA é eminentemente cirúrgico. Sendo o tratamento conservador indicado em casos selecionados. É de suma importância que tanto neurocirurgiões quanto clínicos devam saber identificar os sinais e sintomas característicos para não retardar o tratamento. Além disso, a abordagem minimamente invasiva vem ganhando notoriedade nas últimas décadas, associada aos procedimentos guiados por imagem, e, quando bem indicadas, resultam numa rápida recuperação e menor morbidade.

Keywords

acute intracranial epidural hematoma - head trauma - treatment - craniotomy - conservative treatment - endovascular embolization

Palavras-chave

hematoma epidural agudo intracraniano - traumatismo cranioencefálico - tratamento - craniotomia - tratamento conservador - embolização endovascular


Publikationsverlauf

Eingereicht: 15. Februar 2024

Angenommen: 18. Oktober 2024

Artikel online veröffentlicht:
11. Dezember 2024

© 2024. Sociedade Brasileira de Neurocirurgia. 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/)

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