Epidemiological Analysis of Surgically Treated Acute Traumatic Epidural Hematoma

Abstract

This study is a retrospective analysis of demographic, clinical, radiological and outcome data of surgically treated acute traumatic epidural hematomas. Forty-six consecutive cases of epidural hematomas were operated at the University Hospital Center of Yaoundé, Cameroon, between February 2006 and December 2013. The mean age was 29.56 years and63.04% of patients were between 21 and 30 years. Almost 94% of patients were males. Thirty-five percent of patients were motorcycle riders. Road traffic accident was the cause in 70% of cases. Mean time between head trauma and surgical evacuation was 78 hours. Head trauma was moderate in 52.17%. Initial loss of consciousness was found in 78.26% and lucid interval in 65.23%. Seventy-four percent of patients had signs of intracranial hypertension on admission, 35% had at least one neurologic focal sign and 50% had a scalp wound. Eight patients (17.39%) presented with unilateral or bilateral mydriasis. On computed tomography, the hematoma was on the left side in 60.86% of patients and frontal-parietal location was the most frequent. Computed tomography showed mass effect in 97.82% of patients. The most frequent surgical procedure was craniotomy. Six (13.04%) patients died, but 82.60% recovered fully (GOS 5). In Cameroon, traumatic acute epidural hematoma affects primarily healthy young men in their twenties and thirties. Road traffic accidents are the main etiology. Most patients had moderate head trauma and presented with intracranial hypertension. Early surgery is rarely done. Nevertheless, even with delayed surgery, most patients have good outcome.

Outcome of Surgically Treated Acute Traumatic Epidural Hematomas Based on the Glasgow Coma Scale

“…This was the case for any patient of the present series, since all of them needed an emergency surgical removal of their are not limited to: preoperative neurologic status i.e. preoperative GCS score/ motor score, delay between trauma and operation, presence of pupillary anomalies, associated intradural injuries, hematoma size or location, age, mass effect with midline shift, and mechanism of injury and so on [1]- [12]. Some are admitted while others are still debated.…”

“…One of the most important predictors for poor outcome of patients with TBI is the presence of a mass lesion requiring surgical removal as it was the case for all patients of this surgical series [12]. Factors such as the (initial) Glasgow coma scale (GCS) score or pupillary abnormalities are unanimously admitted while others such as, hematoma volume or thickness or patient age, are diversely appreciated [1]- [12]. The Glasgow coma scale was defined in 1974 by Bryan JENNETT and Graham TEASDALE in order to standardize the assessment of patients with consciousness impairment [13].…”

“…But, if left untreated, death can occur very fast. EDH is a neurosurgical emergency for which many prognostic factors have been determined [1]- [12]. One of the most important predictors for poor outcome of patients with TBI is the presence of a mass lesion requiring surgical removal as it was the case for all patients of this surgical series [12].…”

“…An acute traumatic epidural hematoma (ATEDH) is part of traumatic brain injury (TBI) which is a worldwide health problem with huge socio-economic impact [1]. If treated promptly and efficiently, the outcome of ATEDH is favorable in most cases.…”

“…Nonetheless, the initial GCS score after resuscitation or prior to surgery, of patients with acute traumatic EDH is the strongest prognostic indicator for outcome [11]. The mortality of EDH patients with mild TBI treated surgically is near zero while that of patients with severe TBI remains significant even with prompt surgical removal [1]- [12]. Usually, outcome of patients with acute brain insults such as TBI or SAH is evaluated using the Glasgow outcome score (GOS) [2], the extended GOS, and the Rankin or modified Rankin scales.…”