Our Experience with Surgically Treated Epidural Hematomas in Children

Abstract

ObjectiveTraumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on period and region of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children.MethodsThis is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients' medical records, computed tomographic (CT) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe extracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury.ResultsThe mean (SD) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cases, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hematoma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI revealed brain contusion in 5 patients, and diffuse axonal injury in one patient. The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance.ConclusionRegardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent.

Assessment of energy expenditure in individuals with post-poliomyelitis syndrome

“…This finding can be seen both in studies in the United States 29 and in other Brazilian studies 2,30 . The study by Conde et al 30 showed that fatigue in patients with PPS is not related to time of day (morning or evening) but with the type of activity.…”

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.…”

“…[812] The incidence of associated skull base fractures is lower, the course is more insidious and the signs, symptoms, and outcomes are different from adults. [81214] These make them difficult to diagnose and manage. The reported mortality rates are between 0% and 12%.…”

Distinct Strategies in the Treatment of Epidural Hematoma in Children: Clinical Considerations

“…Several pediatric case series concerning various strategies of treatment of EDH have been published so far [13], our series, however, seems to be the largest in the past 10 years. Presented data reveal an increasing trend in the diagnostics and surgical treatment of EDH in children.…”