Conservative Management of Acute Epidural Hematoma in a Pediatric Age Group

Jamous, Mohammad; Aziz, Hani Abdel; Kaisy, Farouk Al; Eloqayli, Haytham; Azab, Mohammed; Al-Jarrah, Muhammed

doi:10.1159/000218200

Cited by 47 publications

(52 citation statements)

References 18 publications

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“…Although the EDH measurements were larger in the surgery cohort, there were several patients with normal mental status and large hematomas (>15 mm diameter) who were observed with good outcomes, indicating that EDH size alone should not dictate operative decision making. There has previously been concern that patients with EDH in the temporal or posterior fossa region are at higher risk for poor outcomes [14,17,18,19,20,21]. However, our observed population included 17 patients with EDH in the temporal region, further supporting the growing body of evidence that hematoma location should not be an absolute indication for surgery [22,23].…”

Section: Discussionsupporting

confidence: 52%

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Flaherty¹,

Loya²,

Alexander³

et al. 2013

Pediatr Neurosurg

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Background: There are currently no clear guidelines for the management and radiological monitoring of pediatric patients with epidural hematomas (EDH). We aim to compare clinical and radiographic characteristics of pediatric EDH patients managed with observation alone versus surgical evacuation and to describe results of repeat head imaging in both groups. Methods: We performed a retrospective observational study of pediatric patients diagnosed with traumatic EDH at a level II trauma center. Results: Forty-seven cases of EDH were analyzed. Sixty-two percent were managed by observation alone. Patients undergoing surgery were more likely to have an altered mental status (17 vs. 72%, p < 0.001), but there were no other significant clinical differences between the groups. The mean initial EDH thickness and volume were 8.0 mm and 8.6 ml in the observed group and 15.5 mm and 35 ml in the surgery group, respectively (p < 0.001 for both comparisons). Eighty-six percent of the observed and all surgery patients underwent repeat CT imaging. The initial repeat CT scan results led to surgery in 1 patient who was initially treated with observation. Conclusions: Most pediatric patients with EDH can be managed with observation. Mental status and radiographic findings should guide the need for surgical intervention. Multiple repeat CT scans have minimal utility in changing management.

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Section: Discussionsupporting

confidence: 52%

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Flaherty¹,

Loya²,

Alexander³

et al. 2013

Pediatr Neurosurg

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“…2,5) In our patient, CT performed 8 hours after the trauma showed enlargement of the EDH, but no symptoms or signs were observed. Therefore, we did not perform craniotomy and evacuation.…”

Section: Discussionmentioning

confidence: 49%

Spontaneous Slow Drainage of Epidural Hematoma Into the Subgaleal Space Through a Skull Fracture in an Infant -Case Report-

Chida

Yukawa

Mase

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 4-month-old girl fell off a table onto the floor. Computed tomography performed 4 hours after the trauma showed a left parietal epidural hematoma (EDH) with an omega-shaped fracture line in the left parietal region. The EDH was enlarged after another 4 hours. However, the EDH showed drainage into the subgaleal space through the skull fracture 2 days after the trauma and was almost completely discharged into the subgaleal space by 5 days after trauma. Both the EDH and the subgaleal hematoma had resolved completely by 12 days after the trauma. No symptoms or signs were observed during the course. This case suggests that EDH can drain slowly and spontaneously into the subgaleal space through a skull fracture in an infant.

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“…For example, in some patients with a Glasgow Coma Scale score of 14 or 15 the lesions were successfully managed without surgical intervention, although the EDHs were caused by mild trauma unrelated to craniotomy. 1,10 In our study, surgery was determined by the symptoms, signs, and volume of the hematoma. Although in 15 of 16 cases in which conservative management was chosen, the individuals recovered fully without any neurological deterioration, 1 had fine motor dysfunction of the hand.…”

Section: Discussionmentioning

confidence: 99%

Postoperative epidural hematoma covering the galeal flap in pediatric patients with moyamoya disease: clinical manifestation, risk factors, and outcomes

Choi

Lee

Kim

et al. 2013

PED

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Object Postoperative epidural hematoma (EDH), a blood collection between the inserted galeal flap and the overlying skull flap (epigaleal flap hematoma), is a frustrating complication of the surgical treatment of moyamoya disease (MMD) in pediatric patients. The symptoms of postoperative EDH are often similar to those of postoperative cerebral ischemia, and may cause confusion during clinical decision making. The authors designed this study to evaluate the incidence, clinical presentation, risk factors, and treatment outcomes of postoperative EDH in pediatric patients with MMD. Methods A retrospective review of 148 pediatric patients with 250 craniotomies who underwent indirect bypass revascularization surgery between January 2002 and December 2006 was performed. This group consisted of 60 male and 88 female patients, and the mean age at surgery was 7.5 years (range 1–18 years). Results Of the 250 craniotomies, postoperative EDH was detected in 32 cases. In 12 cases of EDH, surgical treatment was necessary (4.8% of 250 craniotomies). During the same period, 743 non-MMD craniotomy operations were performed. In 6 of these 743 operations, patients developed postoperative EDH that required surgical treatment, significantly less than the percentage of EDH requiring postoperative treatment in patients with MMD (0.8%, p < 0.001). The average interval between craniotomy surgery and the detection of EDH was 1.8 days (range 0–5 days) in patients with MMD and 0.5 days (range 0–2 days; p = 0.018) in the non-MMD craniotomy group. Postoperative EDH was observed in significantly fewer cases (17 of 191) when a subcutaneous drain (SCD) was inserted over the bone flap than in cases in which an SCD was not inserted (14 of 55; p = 0.001). The mean international normalized ratio of prothrombin time in the immediate postoperative blood test was 1.27 ± 0.17 in the EDH group and 1.20 ± 0.11 in the non-EDH group (values are expressed as the mean ± SD; p = 0.008). Central galeal flap tenting suture and immediate postoperative platelet count were not related to the incidence of postoperative EDH following pediatric MMD surgery. Conclusions Postoperative EDH is more likely to be found following craniotomy in patients with MMD than in those without MMD, and may occur in a delayed fashion. Insertion of an SCD and immediate correction of an abnormal value for international normalized ratio of prothrombin time can decrease the incidence of postoperative EDH following surgery for pediatric MMD.

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Conservative Management of Acute Epidural Hematoma in a Pediatric Age Group

Cited by 47 publications

References 18 publications

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Spontaneous Slow Drainage of Epidural Hematoma Into the Subgaleal Space Through a Skull Fracture in an Infant -Case Report-

Postoperative epidural hematoma covering the galeal flap in pediatric patients with moyamoya disease: clinical manifestation, risk factors, and outcomes

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