Benign extradural haemorrhage: scope of conservative trial

Abstract

Background Epidural hematomas have been treated with urgent surgical evacuation to prevent catastrophic neurological sequelae and death. Brain Trauma Foundation recommends EDH volume greater than 30 cm3 and warrants surgical evacuation irrespective of GCS. However, due to increase in number of patients undergoing brain CTs following head injuries, more patients have been detected with EDH causing minimal symptoms. Aims and objectives To study factors influencing patients being treated conservatively for head injury with supratentorial epidural hematomas. Material and methods Our study is a retrospective analysis of supratentorial epidural hematoma treated conservatively from august 2018 to July 2020 at Sher-i-Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir. Results A total of 19 patients with EDH were treated conservatively and fulfilled the inclusion criteria.(GCS of 13–15 with no neurological deficit, mild signs of elevated ICP, EDH thickness < 1.5 cm on CT, EDH volume on CT < 30 ml, midline shift on CT less than or equal to 5 mm with no significant intradural pathology)Age ranged from 2 months to 70 years (average 27.15 yrs)males (89.47%) predominated females (10.53%). Motor vehicular accidents were the most common mode of injury (42.1%). EDH was localised 13 times on right side, 5 times on left side and bilateral in one, supratentorially. A midline shift of 5 mm was found in 3 of 19 patients; GCS was > 13 on admission. 8 patients were hospitalised for a week, whilst 2 patients stayed in the hospital for 20 and 25 days, respectively, due to problems not related to EDH. One patient in whom conservative treatment had to be changed to surgical evacuation after 6 days of observation because of worsening headache, impaired alertness repeated imaging showed slight increase in EDH. Conclusions EDH can be managed conservatively in carefully selected patients of minor head injury with radiological surveillance and close neurological monitoring. Patients with GCS on admission more than 13, midline shift of less than 5 mm, location and volume of EDH less than 30 ml. Thus, leading to optimal utilisation of hospital resources. So, we conclude that even a dreaded entity like extradural haemorrhage can be managed conservatively in selected cases with strict clinical and radiological surveillance. We have called them ‘’Benign extradural haemorrhages’’.