The Surgical Outcome of Traumatic Extra-Axial Hematomas Causing Brain Herniation in Children

Abstract

Aim: The aim of this study was to assess the surgical outcome and prognostic importance of clinical and radiological data from children operated on under emergency conditions due to an extra-axial hematoma causing brain herniation. Methods: This retrospective study included 25 children operated on due to herniated traumatic extra-axial hematomas from January 2000 to December 2010. Results: Of those 25 children, 17 (68%) were diagnosed with subdural hematoma (SDH), 7 (28%) with epidural hematoma (EDH) and only 1 patient (4%) suffered from both SDH and EDH. Overall mortality from a herniated extra-axial hematoma was 44%. The mortality rate for herniated SDH patients was 52.9%, and only 1 patient died from a herniated EDH (14.2%). Low Glasgow coma scale scores at admission, high postoperative intracranial pressure (ICP) values, longer intervals from trauma to surgery, longer durations of brain herniation, the presence of intraoperative brain swelling, larger and thicker hematomas and more displacement of the midline structures and obliteration of the basal cisterns were all correlated with mortality and an unfavorable outcome. Conclusions: Brain herniation is a serious consequence of traumatic extra-axial hematomas in children, and approximately one third of these patients have the potential for a favorable outcome. We recommend postoperative ICP monitoring to predict outcome and early decompressive surgery when possible for promising results.

Initial Factors Affecting 6-month Outcome of Patients Undergoing Surgery for Acute Post-traumatic Subdural and Epidural Hematoma

“…5,6 The authors investigating the patients operated on due to extra-axial hematoma also found an important impact of GCS and the pupil response on the outcome. 8,14,15 Our study confirmed this result in both groups. Dysautonomia or autonomic dysfunction is a condition in which the autonomic nervous system does not work properly.…”

“…The authors studying patients with EDH and SDH found a poorer outcome associated with a greater midline shift and the thickness of hematoma. 14,15,31 Our analysis confirms these relationships. Similarly, the greater the thickness of hematoma is, the worse the prognosis in the EDH and SDH groups is.…”

“…38 They came to similar conclusions. 14,39 Khaled et al, investigating patients with EDH, stated that the time between a trauma and a surgery is the most important prognostic factor, and shortening this time to a minimum can reduce mortality to zero. 11 Seelig et al based on patients undergoing surgery for SDH found that surgery reduces mortality from 90% to 30% within 4 hours.…”

Retrospective clinical evaluation of patients undergoing surgery for acute epidural hematoma

“…We also noted that the postoperative recovery was better in patients with high GCS scores. The evaluation of the patients who underwent surgery revealed that the median GCS scores of those who died and who survived following surgery were 6 (4-12) and 12 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), respectively; the difference was statistically significant (p < 0.001). Araujo et al (2012) reported that the primary location was the temporoparietal region in 26.5% of the patients.…”

Decompressive craniectomy for traumatic intracranial hypertension: application in children

“…The presence of radiological features is often helpful in determining the necessity to decompress. Midline shift of the brain on computed tomography (CT) is highly prognostic in children with the degree of shift being inversely related to outcome [ 33 ]. Interestingly, in adults, where an absence or compression of the basal cisterns is predictive of poor outcome [ 34 ], in the paediatric population, patent basal cisterns do not exclude high ICP [ 35 ] and extra caution should be observed (Fig.…”