The expectant treatment of "asymptomatic" supratentorial epidural hematomas.
Seventy-four patients with a traumatic epidural hematoma (EDH) and a Glasgow Coma Scale score of more than 12 received expectant treatment; 14 subsequently underwent surgical evacuation of the EDH. A patient with initial brain computed tomograms (CT) showing an EDH volume of more than 30 ml, a thickness of more than 15 mm, and a midline shift beyond 5 mm tended to require surgery within 3 days of the injury when the brain had exhausted its compensatory mechanism and yielded to the expanding EDH. After the 3-day period, in the absence of neurological symptoms, the presence of the EDH may not be an indication for surgical evacuation or hospitalization beyond 7 days. In our patients, the presence of a skull fracture in the temporal bone, the heterogeneous density of the EDH in the CT scan, or the 6-hour period between the CT study and the injury did not significantly increase the failure rate of nonsurgical treatment. Although a zero mortality was achieved in this series, these guidelines may not be applicable to the management of an infratentorial EDH.
Chen
T Y
TY
Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Wong
C W
CW
Chang
C N
CN
Lui
T N
TN
Cheng
W C
WC
Tsai
M D
MD
Lin
T K
TK
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008297:Male; D012887:Skull Fractures / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed