Surgical management of acute epidural hematomas.
An epidural hematoma (EDH) greater than 30 cm3 should be surgically evacuated regardless of the patient's Glasgow Coma Scale (GCS) score. An EDH less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift (MLS) in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic (CT) scanning and close neurological observation in a neurosurgical center.


METHODS
It is strongly recommended that patients with an acute EDH in coma (GCS score < 9) with anisocoria undergo surgical evacuation as soon as possible.


METHODS
There are insufficient data to support one surgical treatment method. However, craniotomy provides a more complete evacuation of the hematoma.
Bullock
M Ross
MR
Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Chesnut
Randall
R
Ghajar
Jamshid
J
Gordon
David
D
Hartl
Roger
R
Newell
David W
DW
Servadei
Franco
F
Walters
Beverly C
BC
Wilberger
Jack E
JE
D019468:Disease Management; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*