Conservative management of extradural haematomas

Cucciniello, B; Martellotta, N; Nigro, Domenico Salvatore; Citro, E

doi:10.1007/bf02001469

Cited by 42 publications

(22 citation statements)

References 27 publications

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“…But the size and location of EDH were not absolute contra-indications for nonoperative management. In previous reports, less than 15 mm for the maximal thickness of the clot or less than 50 cc for the voIume of the cIot were suggested for conservative treatment [5,12,16]. Although these criteria are usually accepted, several cases of more than 20 mm were also treated conservatively [6,18,21].…”

Section: Discussionmentioning

confidence: 96%

“…Some of them are the formation of a fibrovascular neomembrane as an absorbing structure, development of an arteriovenous shunting and the transfer of the clot to the epicranial space through a fracture [1,12,14,18,21]. A skull fracture was observed in 65-100 percent of the patients with EDH [4,5,8,10,11,13,17]. It is well known that some skull fractures can not be shown by neuroradiologic techniques.…”

Section: Discussionmentioning

confidence: 97%

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Conservative management of extradural haematomas: Effects of skull fractures on resorption rate

et al. 1997

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In conservative management of extradural haematomas (EDH), several mechanisms were described to explain the resorption of the haematoma. One of these was the transfer of the clot into the epicranial space through the skull fracture. In this study, the effects of skull fracture and associated intracranial lesions in the conservative management of EDH were investigated. Skull fracture and associated intracranial lesions were found in 71.11% and 51.1% of the patients, respectively. Resorption rate was calculated using an original formula and it was 0.548 +/- 0.227 in patients with skull fracture and 0.507 +/- 0.170 in patients with both skull fractures and additional intracranial lesions. These rates were found to be significantly higher than in the patients without fracture. In conclusion, in the patients with EDH planned to be managed conservatively, skull fracture and additional intracranial lesions must not be thought as risk factors, on the contrary, resorption of the clot might be earlier than in the others.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 97%

Conservative management of extradural haematomas: Effects of skull fractures on resorption rate

et al. 1997

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“…Clinical signs of these effects vary according to the location of the hematoma. Most traumatic epidural hematomas become rapidly symptomatic, but cases of delayed radiographical and clinical appearance of these lesions have also been documented (Phomprasat et al, 1980;Cucciniello et al, 1993;Lobato et al, 1991;Chandrasekaran et al, 1993;Gelabert, 1993).…”

Section: Mechanism Of Injurymentioning

confidence: 99%

Traumatic Extradural Hematoma Overview, Clinical Study and Management

Alakaishy¹,

Hejaju²,

Yaqoobi³

et al. 2017

Int.J.Curr.Res.Aca.Rev.

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Article InfoThe study was conducted at neurosurgical hospital in Baghdad depending on patient's case sheet data. The study was carried retrospectively. The patients from 1.1.2004 till 1.5.2005 were taken in consideration and we found 50 cases treated by surgical intervention and 12 cases treated conservatively. Patients with EDHs less than 0.5 cm were treated conservatively and those with postoperative EDHs of elective neurosurgical procedures in addition to incompletely filled patients' files were excluded. All patients data were recorded including the demographic characteristics and clinical parameters: side, site and size of haematoma (maximum thickness). The study concluded that conservative treatment had a role in management of EDHs.

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“…Several recent reports describe unsuccessful attempts of non-surgical management of acute epidural hematomas [2][3][4]18]. The decision to manage an acute EDH conservatively is based on size of the lesion, secondary mass effect through midline shift, localization of the lesion and clinically no or little neurological deficit [19].…”

mentioning

confidence: 99%

“…Conservative management is only suggested for EDH that are less than 1.5 cm in width with no additional midline shift [5,16]. A midline shift of more than 5 mm has been correlated with enlarging hematomas and the failure of non-operative management [4]. Posterior fossa EDH is considered to be less favorable because even slight enlargement of such clots can cause herniation and brainstem compression.…”

mentioning

confidence: 99%

Possible Mechanisms for Rapid Spontaneous Resolution of Acute Epidural Hematomas

Wagner

Freudenstein

Friese

et al. 2002

Klinische Neuroradiologie

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Background: Acute epidural hematomas (EDH), often associated with additional cranial and extracranial injury, are a serious condition which requires immediate surgical evacuation. Otherwise there is a high risk of quick deterioration and death. Only small asymptomatic hematomas can be treated conservatively with close observation. Case Report: We present a case of complete resolution of a traumatic posterior fossa EDH within 1 hour. Conclusion: Several possible mechanisms of spontaneous resorption are discussed with a review of literature regarding the conservative treatment of acute epidural hemorrhage. This is the first description of the spontaneous resolution of an acute traumatic EDH within 1 hour. Mögliche Wege der raschen spontanen Resorption von akuten epiduralen Hämatomen. Fallbericht und LiteraturübersichtZusammenfassung Hintergrund: Akute traumatische, epidurale Hämatome sind häufig eine lebensbedrohliche Erkrankung. Sie erfordern eine rasche neurochirurgische Behandlung durch Hämatomausräumung, da sich der klinische Zustand des Patienten sonst in kurzer Zeit verschlechtern und die Raumwirkung des Hämatoms auf das Gehirn zum Tode führen kann. Nur kleine epidurale Hämatome, die sich klinisch asymptomatisch darstellen, können konservativ erfolgreich behandelt werden. Eine engmaschige Überwachung der Patienten ist jedoch erforderlich. Fallbeschreibung: Wir berichten über einen Patienten mit einem ausgedehnten traumatischen epiduralen Häma-tom in der hinteren Schädelgrube, das sich innerhalb einer Stunde spontan resorbierte. Schlussfolgerungen: Es werden mögliche Resorptionsmechanismen beschrieben und die vorhandene Literatur zur konservativen Behandlung akuter epiduraler Hämatome besprochen. Die vorliegende Arbeit befasst sich erstmals mit der spontanen Resorption eines akuten traumatischen epiduralen Hämatoms innerhalb 1 Stunde. Schlüsselwörter: Akutes epidurales Hämatom · Spontane Resorption · Intrakranielle Verletzung · Konservative Behandlung von epiduralen Hämatomen

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Conservative management of extradural haematomas

Abstract: The personal experiences with a series of 57 conservatively treated extradural haematomas (EDH) are presented and the criteria for conservative management outlined. Main preconditions are absence of neurological deficit, close clinical supervision and repeated CT check-ups.

Cited by 42 publications

References 27 publications

Conservative management of extradural haematomas: Effects of skull fractures on resorption rate

Conservative management of extradural haematomas: Effects of skull fractures on resorption rate

Traumatic Extradural Hematoma Overview, Clinical Study and Management

Possible Mechanisms for Rapid Spontaneous Resolution of Acute Epidural Hematomas

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