title: The expectant treatment of "asymptomatic" supratentorial epidural hematomas.
abstract: 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.
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
authors.forename: T Y
authors.initials: TY
authors.lastname: Chen
authors.forename: C W
authors.initials: CW
authors.lastname: Wong
authors.forename: C N
authors.initials: CN
authors.lastname: Chang
authors.forename: T N
authors.initials: TN
authors.lastname: Lui
authors.forename: W C
authors.initials: WC
authors.lastname: Cheng
authors.forename: M D
authors.initials: MD
authors.lastname: Tsai
authors.forename: T K
authors.initials: TK
authors.lastname: Lin
mesh_terms: 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