Extradural Hematoma: Analysis of Factors Influencing the Courses of 161 Patients

Abstract

The clinical and computed tomographic (CT) findings in a series of 161 consecutive patients operated upon for postraumatic extradural hematoma are analyzed. Thirteen (8%) patients had delayed epidural hematoma formation. The overall mortality for the series was 12%, significantly lower than that observed during the prior "angiographic" period at the same unit (30%). Because all but 1 of the deaths occurred among the 66 patients unconscious at the time of operation (27% mortality in this subgroup), the authors sought differential factors between comatose and noncomatose patients at operation. There were no significant differences between these groups in age, sex, mechanism of injury, preoperative course of consciousness (lucid interval or not), or epidural hematoma location and shape. In contrast, significant differences were seen between the two subgroups in trauma-to-operation interval, hematoma volume, CT hematoma density (mixed low-high CT density vs. homogeneous hyperdensity), midline displacement, severity of associated intracranial lesions, and postoperative intracranial pressure (ICP). Patients comatose at operation usually evidenced a more rapid clinical deterioration (a shorter trauma-to-operation interval) and tended to have a large hematoma volume, a higher incidence of mixed CT density clot (hyperacute bleeding), more marked shift of midline structures, more severe associated lesions, and higher postoperative ICP levels.

The surgical outcome of traumatic extraaxial hematomas causing brain herniation

“…Yanaka et al (48), showed that greater hematoma volume and the thickness of SDH was associated with poor outcome and mortality. Many other authors reported similar findings for both EDH and SDH (11,22,30,45). We also demonstrated in our study that the larger the hematoma volume and the thickness, the higher the incidence of mortality and unfavorable outcome.…”

“…Pupils that are bilaterally unresponsive to light are associated with a high mortality (4,8,9,25,30,45). Patients with bilateral fixed and dilated pupils at surgery had 0-13% favorable outcome and 64-93% mortality rate (13,29,31,38,46).…”

Extradural Haematoma in Children: Surgical Experiences and Prospective Analysis of 138 Cases

“…Kuday et al 25 observed a significant relationship between cranial fractures and adverse outcome in 115 patients undergoing surgery for EDH. Lee et al 27 did not see this relationship in a series of 200 patients managed similarly .But Rivas et al 28 reported a significantly lower mortality rate in patients with cranial fractures which is in strong agreement with our findings.…”

Etiological Factors of Extradural Haematoma: Experience of 80 Cases in Bangladesh

“…The prognosis is nevertheless influenced by: age, degree of coma, pupillary reaction to light, size and site of haematoma and the mechanism of injury (Baykaner et al, 1988;Lobato et al, 1988). Delayed operative treatment of EDH is recognized as a poor prognostic factor.…”