Epidural hematoma surgery: Difference between revisions
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==Overview== | ==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|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 tomography|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== | ==Indications== | ||
* | *An epidural hematoma greater than 30 cm3 should be surgically evacuated regardless of the patient's [[Glasgow coma scale|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 tomography|computed tomographic scanning]] and close neurological observation in a neurosurgical center.<ref name="pmid16710967" /> | ||
==Surgery== | ==Surgery== | ||
*[[Surgery]] is the mainstay of treatment for epidural hematoma.<ref name="pmid24032078">{{cite journal| author=Khan MB, Riaz M, Javed G, Hashmi FA, Sanaullah M, Ahmed SI| title=Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= | pages= 103 | pmid=24032078 | doi=10.4103/2152-7806.116425 | pmc=3766325 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24032078 }} </ref><ref name="pmid22216933">{{cite journal| author=Habibi Z, Meybodi AT, Haji Mirsadeghi SM, Miri SM| title=Burr-hole drainage for the treatment of acute epidural hematoma in coagulopathic patients: a report of eight cases. | journal=J Neurotrauma | year= 2012 | volume= 29 | issue= 11 | pages= 2103-7 | pmid=22216933 | doi=10.1089/neu.2010.1742 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22216933 }} </ref><ref name="pmid11995217">{{cite journal| author=Korinth M, Weinzierl M, Gilsbach JM| title=[Treatment options in traumatic epidural hematomas]. | journal=Unfallchirurg | year= 2002 | volume= 105 | issue= 3 | pages= 224-30 | pmid=11995217 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11995217 }} </ref> | *[[Surgery]] is the mainstay of treatment for epidural hematoma.<ref name="pmid24032078">{{cite journal| author=Khan MB, Riaz M, Javed G, Hashmi FA, Sanaullah M, Ahmed SI| title=Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= | pages= 103 | pmid=24032078 | doi=10.4103/2152-7806.116425 | pmc=3766325 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24032078 }} </ref><ref name="pmid22216933">{{cite journal| author=Habibi Z, Meybodi AT, Haji Mirsadeghi SM, Miri SM| title=Burr-hole drainage for the treatment of acute epidural hematoma in coagulopathic patients: a report of eight cases. | journal=J Neurotrauma | year= 2012 | volume= 29 | issue= 11 | pages= 2103-7 | pmid=22216933 | doi=10.1089/neu.2010.1742 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22216933 }} </ref><ref name="pmid11995217">{{cite journal| author=Korinth M, Weinzierl M, Gilsbach JM| title=[Treatment options in traumatic epidural hematomas]. | journal=Unfallchirurg | year= 2002 | volume= 105 | issue= 3 | pages= 224-30 | pmid=11995217 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11995217 }} </ref> | ||
*An epidural hematoma greater than 30 cm3 should be surgically evacuated regardless of the patient's [[Glasgow coma scale|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 tomography|computed tomographic scanning]] and close neurological observation in a neurosurgical center.<ref name="pmid16710967">{{cite journal| author=Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW et al.| title=Surgical management of acute epidural hematomas. | journal=Neurosurgery | year= 2006 | volume= 58 | issue= 3 Suppl | pages= S7-15; discussion Si-iv | pmid=16710967 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16710967 }} </ref> | *An epidural hematoma greater than 30 cm3 should be surgically evacuated regardless of the patient's [[Glasgow coma scale|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 tomography|computed tomographic scanning]] and close neurological observation in a neurosurgical center.<ref name="pmid16710967">{{cite journal| author=Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW et al.| title=Surgical management of acute epidural hematomas. | journal=Neurosurgery | year= 2006 | volume= 58 | issue= 3 Suppl | pages= S7-15; discussion Si-iv | pmid=16710967 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16710967 }} </ref> | ||
Revision as of 16:53, 6 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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]
- 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.
- ↑ 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.
Overview
Surgery
As with other types of intracranial hematomas, the blood may be aspirated surgically to remove the mass and reduce the pressure it puts on the brain.[1] The hematoma is neurosurgically evacuated through a burr hole or craniotomy. The diagnosis of epidural hematoma requires a patient to be cared for in a facility with a neurosurgeon on call to decompress the hematoma if necessary and stop the bleed by ligating the injured vessel branches.
- ↑ McCaffrey P. 2001. "The Neuroscience on the Web Series: CMSD 336 Neuropathologies of Language and Cognition." California State University, Chico. Retrieved on February 6, 2007.