Epidural hematoma surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Surgery is the mainstay of treatment for epidural hematoma. An epidural hematoma greater than 30 cm3 should be surgically evacuated regardless of the patient's Glasgow Coma Scale (GCS) score. An epidural hematoma less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic scanning and close neurological observation in a neurosurgical center. Acute epidural hematoma with a small amount of bleeding(less than 50 mL)may be treated by minimal invasive surgery methods which avoids craniotomy.
Indications
- An epidural hematoma greater than 30 cm3 should be surgically evacuated regardless of the patient's Glasgow Coma Scale (GCS) score. An epidural hematoma less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic scanning and close neurological observation in a neurosurgical center.[1]
Surgery
- Surgery is the mainstay of treatment for epidural hematoma.[2][3][4]
- An epidural hematoma greater than 30 cm3 should be surgically evacuated regardless of the patient's Glasgow Coma Scale (GCS) score. An epidural hematoma less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic scanning and close neurological observation in a neurosurgical center.[1]
- For patients with slowly-developing epidural hematoma in the context of impaired coagulation, burr-hole evacuation and drainage may be a less invasive method of treatment compared to conventional craniotomy.[3]
- Acute epidural hematoma with a small amount of bleeding(less than 50 mL)may be treated by minimal invasive surgery methods which avoids craniotomy.[5]
Contraindications
References
- ↑ 1.0 1.1 Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW; et al. (2006). "Surgical management of acute epidural hematomas". Neurosurgery. 58 (3 Suppl): S7–15, discussion Si-iv. PMID 16710967.
- ↑ Khan MB, Riaz M, Javed G, Hashmi FA, Sanaullah M, Ahmed SI (2013). "Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country". Surg Neurol Int. 4: 103. doi:10.4103/2152-7806.116425. PMC 3766325. PMID 24032078.
- ↑ 3.0 3.1 Habibi Z, Meybodi AT, Haji Mirsadeghi SM, Miri SM (2012). "Burr-hole drainage for the treatment of acute epidural hematoma in coagulopathic patients: a report of eight cases". J Neurotrauma. 29 (11): 2103–7. doi:10.1089/neu.2010.1742. PMID 22216933.
- ↑ Korinth M, Weinzierl M, Gilsbach JM (2002). "[Treatment options in traumatic epidural hematomas]". Unfallchirurg. 105 (3): 224–30. PMID 11995217.
- ↑ Wang W (2016). "Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series". Biomed Res Int. 2016: 6507350. doi:10.1155/2016/6507350. PMC 4837251. PMID 27144170.