title: The surgical outcome of traumatic extra-axial hematomas causing brain herniation in children.
abstract: OBJECTIVE
  The aim of this study was to assess the surgical outcome and prognostic importance of clinical and radiological data from children operated on under emergency conditions due to an extra-axial hematoma causing brain herniation.
  
  
  METHODS
  This retrospective study included 25 children operated on due to herniated traumatic extra-axial hematomas from January 2000 to December 2010.
  
  
  RESULTS
  Of those 25 children, 17 (68%) were diagnosed with subdural hematoma (SDH), 7 (28%) with epidural hematoma (EDH) and only 1 patient (4%) suffered from both SDH and EDH. Overall mortality from a herniated extra-axial hematoma was 44%. The mortality rate for herniated SDH patients was 52.9%, and only 1 patient died from a herniated EDH (14.2%). Low Glasgow coma scale scores at admission, high postoperative intracranial pressure (ICP) values, longer intervals from trauma to surgery, longer durations of brain herniation, the presence of intraoperative brain swelling, larger and thicker hematomas and more displacement of the midline structures and obliteration of the basal cisterns were all correlated with mortality and an unfavorable outcome.
  
  
  CONCLUSIONS
  Brain herniation is a serious consequence of traumatic extra-axial hematomas in children, and approximately one third of these patients have the potential for a favorable outcome. We recommend postoperative ICP monitoring to predict outcome and early decompressive surgery when possible for promising results.
authors: Neurosurgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, Ministry of Health, Istanbul, Turkey.
authors: Bora
authors: B
authors: Gürer
authors: Hayri
authors: H
authors: Kertmen
authors: Erdal R
authors: ER
authors: Yilmaz
authors: Zeki
authors: Z
authors: Sekerci
mesh_terms: D000293:Adolescent; D001929:Brain Edema / Q000209:etiology / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000150:complications / Q000401:mortality / Q000601:surgery; D006408:Hematoma, Subdural / Q000150:complications / Q000401:mortality / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome