The Expectant Treatment of “Asymptomatic” Supratentorial Epidural Hematomas

Chen, Tzu Yung; Wong, Cheuk Wah; Chang, Chih-Ching; Lui, Tai Ngar; Cheng, Wan Chun; Tsai, Ming‐Song; Lin, Tzu Kang

doi:10.1227/00006123-199302000-00004

Cited by 91 publications

(16 citation statements)

References 24 publications

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“…McLauren and Towbin [6 ]mentioned: ‘the definite treatment of EDH should always be surgical removal, and delay of such treatment is unacceptable.’ On the other hand, it is well established that conservative treatment in minor EDH shows perfect outcomes in children [7, 8, 9]. Over the last years, there has been scant literature published concerning operative versus conservative management of EDH in children.…”

Section: Discussionmentioning

confidence: 99%

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Conservative Management of Acute Epidural Hematoma in a Pediatric Age Group

et al. 2009

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Objective: Craniotomy and evacuation is the standard treatment of acute epidural hematoma (EDH). Here, the authors report their experience in nonoperative management of acute EDH in children with mild head injury. Methods: The authors retrospectively reviewed charts of patients with conservatively treated EDH at the Department of Neurosurgery, King Abdulla University Hospital, Irbid, Jordan, between August 2003 and October 2007. All patients had a Glasgow Coma Scale score of 14 or 15, and an initial computerized tomography (CT) scan demonstrating an EDH with or without skull fractures. Follow-up included neurological examination and brain CT. Results: Six children (3 boys, 3 girls) with acute EDH were successfully managed at our department without surgical intervention. The Glasgow Outcome Scale score of all patients was 5, with no posttraumatic sequelae. Follow-up brain CT showed complete resolution of the EDH within 2–3 months. Conclusions: Our results demonstrated that pediatric EDH can be managed nonoperatively. The pronounced increase in the number of CT examinations for patients with head injuries has resulted in a greater proportion of EDH detected in conscious patients. We recommend such treatment be performed in specialized pediatric neurosurgical centers under close neurological observation.

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Section: Discussionmentioning

confidence: 99%

“…Even in EDH in adults, a thickness of less than 1.5 cm in CT, a midline shift of less than 5 mm and a volume less than 30 ml predicted successful outcome of nonoperative management [7]. …”

Section: Discussionmentioning

confidence: 99%

Conservative Management of Acute Epidural Hematoma in a Pediatric Age Group

et al. 2009

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“…Beginning in the 1980s, several case series and prospective reports were published in the literature describing nonsurgical management of such adult patients [6,7]. This research ultimately led to practice guidelines based on clinical and radiographic criteria that help identify which adult patients can safely be observed and how they should be monitored with follow-up imaging [8,9]. …”

Section: Introductionmentioning

confidence: 99%

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Flaherty¹,

Loya²,

Alexander³

et al. 2013

Pediatr Neurosurg

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Background: There are currently no clear guidelines for the management and radiological monitoring of pediatric patients with epidural hematomas (EDH). We aim to compare clinical and radiographic characteristics of pediatric EDH patients managed with observation alone versus surgical evacuation and to describe results of repeat head imaging in both groups. Methods: We performed a retrospective observational study of pediatric patients diagnosed with traumatic EDH at a level II trauma center. Results: Forty-seven cases of EDH were analyzed. Sixty-two percent were managed by observation alone. Patients undergoing surgery were more likely to have an altered mental status (17 vs. 72%, p < 0.001), but there were no other significant clinical differences between the groups. The mean initial EDH thickness and volume were 8.0 mm and 8.6 ml in the observed group and 15.5 mm and 35 ml in the surgery group, respectively (p < 0.001 for both comparisons). Eighty-six percent of the observed and all surgery patients underwent repeat CT imaging. The initial repeat CT scan results led to surgery in 1 patient who was initially treated with observation. Conclusions: Most pediatric patients with EDH can be managed with observation. Mental status and radiographic findings should guide the need for surgical intervention. Multiple repeat CT scans have minimal utility in changing management.

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“…In another study with 74 patients, 12 required surgical intervention due to neurological worsening or increase of the hematoma [4,6]. …”

Section: Discussionmentioning

confidence: 99%

Extradural Hematoma in Children: Case Series of 33 Patients

Teichert¹,

Rosales²,

Lopes³

et al. 2012

Pediatr Neurosurg

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Background: Conservative management of extradural hematomas (EDH) is relatively recent in the literature and there are few papers reporting on the pediatric population. Objective: We conduct a 20-month assessment of the treatment administered for EDH at a pediatric intensive care unit (PICU). Methods: A retrospective case series in the period described above. The main variables studied were the weight and age of the patients, the Pediatric Trauma Score, the mechanism of injury, clinical features, CT findings and the Glasgow Coma Scale score on arrival, and after 12 and 24 h. Also analyzed was whether during primary care either surgical intervention or initial conservative management was recommended. Results: In the 20 months analyzed, 33 EDH patients were admitted to the PICU. Patients had a mean age of 7.42 ± 4.66 years, mean weight of 31.16 ± 16.16 kg and mean Pediatric Trauma Scores of 7.03 ± 3.71. Out of the total sample, surgery was indicated in 12 patients (36.4%) in primary care and 21 patients (63.6%) were treated with initial conservative management. Most of the patients who were given conservative treatment had a Glasgow Coma Scale score of 15 on arrival and maintained this level throughout the hospital stay. The most prevalent sites of the hematomas were the temporal and parietal regions and the most common associated injury was skull fracture. Conclusion: In this case series, conservative treatment of EDH was most frequent; however, which factors are involved in this decision has to be better studied.

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The Expectant Treatment of “Asymptomatic” Supratentorial Epidural Hematomas

Cited by 91 publications

References 24 publications

Conservative Management of Acute Epidural Hematoma in a Pediatric Age Group

Conservative Management of Acute Epidural Hematoma in a Pediatric Age Group

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Extradural Hematoma in Children: Case Series of 33 Patients

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