Extradural haematoma in children: surgical experiences and prospective analysis of 170 cases

Abstract

AIm: We present our experiences in the management of extradural haematoma in children which involved an aggressive diagnostic approach, prompt surgical evacuation results in an excellent outcome. mAterIAl and methOds: 170 EDH patients who underwent surgery in our department from January 2006 to July 2010 included in this prospective study. Each patient evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome.results: Out of 170 cases 72%, (n=122) were boys and 28 %,( n=48) were girls. The boys to girls ratio was 2.54: 1. Age ranged from 1.8 to 18 years with a mean age of 9.49 years. Most of the victims are in the 11-18 years age group 44% ( n=74). The most common mode of injury was fall 41%, (n = 70) followed by Road traffic Accident (RTA) 32%, (n = 54) .The most common clinical presentation was altered sensorium 61 %, (n= 104), followed by headache and/or vomiting 56 %, (n = 96). The mortality rate was 8%.COnClusIOn: EDH is recognized as one of the most rewarding neurosurgical emergencies. It must be diagnosed in the early period of the trauma and evacuated early to prevent potential mortality and morbidity. Different factors affect the outcome of extradural haematoma Surgery including age of the patient, presence of cranial fractures, associated brain lesions and pre-operative neurological condition of patient, duration of time interval between onset of coma and surgical intervention. Better prognosis is seen in patients less than 10 years of age. sOnuÇ: Beyin cerrahisi acil yaklaşımları içerisinde en yüzgüldürücü sonuçları olan patolojilerden birisi de ekstradural hematomlardır. Bu tür hematomlar travmanın erken döneminde tanınmalı ve cerrahi tedavisi mortalite ve morbiditeyi önlemek için en hızlı şekilde yapılmalıdır. Ekstradural hematomların cerrahi sonuçları değişik faktörler tarafından etkilenmektedir; bunlar, hastanın yaşı, kranial kemik kırıklarının olması, beyinde ek lezyonların olması, hastanın ameliyat öncesi klinik durumu ve hastanın komaya giriş süresi ile ameliyata alınış süresi arasında geçen süre gibi etkenler sayılabilir. Yaşı 10'dan küçük olan hastaların prognozu daha iyi olmaktadır.

Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country

“…The incidence of EDH has been reported between 1% and 6% of hospitalized patients following a traumatic brain injury. [581424] Children with EDH are less likely to lose consciousness from the traumatic event and require immediate surgery less frequently. They also show a lower incidence of intradural hematomas compared with adults.…”

Role of Computerized Tomography as Prime Imaging Modality in the Evaluation of Traumatic Brain Injury

“…Out of many factors affecting the outcome, the most important one is the duration of time between accident and surgery; mortality can be close to 0% if this time interval can be minimized. Chowdhury et al 23 stated that EDH is one of the most rewarding neurosurgical emergencies. It must be diagnosed in the early period of the trauma and evacuated early to prevent potential mortality and morbidity.…”

Acute epidural hematoma manifesting with monoplegia in a child: Case report

“…Most of the patients having EDH manifest with altered sensorium. Headache and vomiting is the second most common clinical symptoms on admission [6,7]. Other signs or symptoms include lucid interval, papillary abnormalities, hemiparesis, decerebration, and seizures, heart rate, respiration and blood pressure changes (Cushing reflex) [5][6][7][8].…”

“…EDH may manifest with many different clinical signs and symptoms [3]. Loss of muscle strength is seen usually as hemiparesis in this pathology [5][6][7][8]. However, monoplegia associated with EDH is very rare and literature reveals only one case that had vertex hematoma [9].…”