Surgical management of acute epidural hematomas

M. Ross Bullock, Randall Chesnut, Jamshid Ghajar, David Gordon, Roger Hartl, David W. Newell, Franco Servadei, Beverly C. Walters, Jack E. Wilberger

Research output: Contribution to journalReview article

181 Scopus citations

Abstract

In patients with an acute EDH, clot thickness, hematoma volume, and MLS on the preoperative CT scan are related to outcome. In studies analyzing CT parameters that may be predictive for delayed surgery in patients undergoing initial nonoperative management, a hematoma volume greater than 30 cm 3, an MLS greater than 5 mm, and a clot thickness greater than 15 mm on the initial CT scan emerged as significant. Therefore, patients who were not comatose, without focal neurological deficits, and with an acute EDH with a thickness of less than 15 mm, an MLS less than 5 mm, and a hematoma volume less than 30 cm3 may be managed nonoperatively with serial CT scanning and close neurological evaluation in a neurosurgical center (see Appendix II for measurement techniques). The first follow-up CT scan in nonoperative patients should be obtained within 6 to 8 hours after TBI. Temporal location of an EDH is associated with failure of nonoperative management and should lower the threshold for surgery. No studies are available comparing operative and nonoperative management in comatose patients. The literature supports the theory that patients with a GCS less than 9 and an EDH greater than 30 cm3 should undergo surgical evacuation of the lesion. Combined with the above recommendation, it follows that all patients, regardless of GCS, should undergo surgery if the volume of their EDH exceeds 30 cm3. Patients with an EDH less than 30 should be considered for surgery but may be managed successfully without surgery in selected cases. Time from neurological deterioration, as defined by onset of coma, pupillary abnormalities, or neurological deterioration to surgery, is more important than time between trauma and surgery. In these patients, surgical evacuation should be performed as soon as possible because every hour delay in surgery is associated with progressively worse outcome.

Original languageEnglish (US)
Pages (from-to)S27-S215
JournalNeurosurgery
Volume58
Issue numberSUPPL. 3
DOIs
StatePublished - Mar 1 2006

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Keywords

  • Coma
  • Computed tomographic parameters
  • Craniotomy
  • Epidural
  • Head injury
  • Hematoma
  • Surgical technique
  • Timing of surgery
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Bullock, M. R., Chesnut, R., Ghajar, J., Gordon, D., Hartl, R., Newell, D. W., Servadei, F., Walters, B. C., & Wilberger, J. E. (2006). Surgical management of acute epidural hematomas. Neurosurgery, 58(SUPPL. 3), S27-S215. https://doi.org/10.1227/01.NEU.0000210363.91172.A8