title: Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature.
abstract: BACKGROUND
  Trauma is the leading cause of death in people younger than 45 years and head injury is the main cause of trauma mortality. Although epidural hematomas are relatively uncommon (less than 1% of all patients with head injuries and fewer than 10% of those who are comatose), they should always be considered in evaluation of a serious head injury. Patients with epidural hematomas who meet surgical criteria and receive prompt surgical intervention can have an excellent prognosis, presumably owing to limited underlying primary brain damage from the traumatic event. The decision to perform a surgery in a patient with a traumatic extraaxial hematoma is dependent on several factors (neurological status, size of hematoma, age of patients, CT findings) but also may depend on the judgement of the treating neurosurgeon.
  
  
  METHODS
  A 30-year old man arrived at our Emergency Department after a traumatic brain injury. General examination revealed severe headache, no motor or sensory disturbances, and no clinical signs of intracranial hypertension. A CT scan documented a significant left fronto-parietal epidural hematoma, which was considered suitable for surgical evacuation. The patient refused surgery. Following CT scan revealed a minimal increase in the size of the hematoma and of midline shift. The neurologic examination maintained stable and the patient continued to refuse the surgical treatment. Next follow up CT scans demonstrated a progressive resorption of hematoma.
  
  
  CONCLUSIONS
  We report an unusual case of a remarkable epidural hematoma managed conservatively with a favorable clinical outcome. This case report is intended to rather add to the growing knowledge regarding the best management for this serious and acute pathology.
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Maugeri
authors.affiliation: Department of Orthopaedic, Surgery Rothman Institute, Philadelphia, PA, USA.
authors.forename: David Greg
authors.initials: DG
authors.lastname: Anderson
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences,School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Graziano
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences,School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Meccio
authors.affiliation: Institute of Neurosurgery, Catholic University School of Medicine, Policlinico "A. Gemelli", Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visocchi
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy.
authors.forename: Domenico Gerardo
authors.initials: DG
authors.lastname: Iacopino
mesh_terms: D000328:Adult; D006259:Craniocerebral Trauma / Q000150:complications* / Q000175:diagnosis; D003657:Decision Making; D019468:Disease Management; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed