title: Surgical management of acute epidural hematomas.
abstract: 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.
authors.affiliation: Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
authors.forename: M Ross
authors.initials: MR
authors.lastname: Bullock
authors.forename: Randall
authors.initials: R
authors.lastname: Chesnut
authors.forename: Jamshid
authors.initials: J
authors.lastname: Ghajar
authors.forename: David
authors.initials: D
authors.lastname: Gordon
authors.forename: Roger
authors.initials: R
authors.lastname: Hartl
authors.forename: David W
authors.initials: DW
authors.lastname: Newell
authors.forename: Franco
authors.initials: F
authors.lastname: Servadei
authors.forename: Beverly C
authors.initials: BC
authors.lastname: Walters
authors.forename: Jack E
authors.initials: JE
authors.lastname: Wilberger
mesh_terms: D019468:Disease Management; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*