Conservative management of significant supratentorial epidural hematomas in pediatric patients

Khan, Muhammad Babar; Riaz, Muhammad; Javed, Gohar

doi:10.1007/s00381-014-2391-x

Cited by 19 publications

(15 citation statements)

References 11 publications

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“…Table 5 summarizes the control cohort, which includes the larger published series of patients with conservatively managed EDH. 1,2,5,11,12,14,19,27…”

Section: Resultsmentioning

confidence: 99%

Endovascular management of acute epidural hematomas: clinical experience with 80 cases

Peres¹,

Caldas²,

Puglia³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Small acute epidural hematomas (EDHs) treated conservatively carry a nonmeasurable risk of late enlargement due to middle meningeal artery (MMA) lesions. Patients with EDHs need to stay hospitalized for several days, with neurological supervision and repeated CT scans. In this study, the authors analyzed the safety and efficacy of the embolization of the involved MMA and associated lesions. METHODS The study group consisted of 80 consecutive patients harboring small- to medium-sized EDHs treated by MMA embolization between January 2010 and December 2014. A literature review cohort was used as a control group. RESULTS The causes of head injury were falls, traffic-related accidents (including car, motorcycle, and pedestrian vs vehicle accidents), and assaults. The EDH topography was mainly temporal (lateral or pole). Active contrast leaking from the MMA was seen in 57.5%; arteriovenous fistulas between the MMA and diploic veins were seen in 10%; and MMA pseudoaneurysms were found in 13.6% of the cases. Embolizations were performed under local anesthesia in 80% of the cases, with N-butyl-2-cyanoacrylate, polyvinyl alcohol particles, or gelatin sponge (or a combination of these), obtaining MMA occlusion and complete resolution of the vascular lesions. All patients underwent follow-up CT scans between 1 and 7 days after the embolization. In the 80 cases in this series, no increase in size of the EDH was observed and the clinical evolution was uneventful, without Glasgow Coma Scale score modification after embolization and with no need for surgical evacuation. In contrast, the control cohort from the literature consisted of 471 patients, 82 (17.4%) of whom shifted from conservative treatment to surgical evacuation. CONCLUSIONS This study suggests that MMA embolization is a highly effective and safe method to achieve size stabilization in nonsurgically treated acute EDHs.

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“…Table 5 summarizes the control cohort, which includes the larger published series of patients with conservatively managed EDH. 1,2,5,11,12,14,19,27…”

Section: Resultsmentioning

confidence: 99%

Endovascular management of acute epidural hematomas: clinical experience with 80 cases

Peres¹,

Caldas²,

Puglia³

et al. 2018

Journal of Neurosurgery

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“…Close monitoring by a pediatric neurosurgery unit is required to facilitate emergency hematoma evacuation in cases of neurological aggravation even if the authors do not advocate specific monitoring for such lesions. 16,17 It should be noted that the only child in our series who experienced immediate life-threatening distress was a patient developing an EDH in the posterior fossa. He was admitted to hospital and received special attention to ensure that surgery was readily available.…”

Section: Discussionmentioning

confidence: 91%

“…According to the literature, this varies, ranging from 2.5 days for cases of mild head trauma, 15 7.7 days for head trauma of varying severity 13 to 11.2 days for EDHs without surgical management. 16 In our cohort, the type of lesion affected the duration of the hospital stay. In fact, the presence of multiple lesions, EDHs and SDHs were statistically linked to a longer hospital stay.…”

Section: Discussionmentioning

confidence: 92%

“…However, the systematic surgical indication of EDHs has been challenged. Conservative treatment has already been described in children for hematomas significantly bigger than 10 mm, 16,17 although, in some cases, surgery has been necessary as a secondary measure. Caution must therefore be exercised regarding the conservative treatment of these hematomas.…”

Section: Discussionmentioning

confidence: 99%

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Monitoring Criteria of Intracranial Lesions in Children Post Mild or Moderate Head Trauma

Jacquet

Boetto²,

Sévely

et al. 2018

Neuropediatrics

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Head injury is the most common cause of child traumatology. However, there exist no treatment guidelines in children having intracranial lesions due to minor or moderate head trauma. There is little knowledge about monitoring, clinical exacerbation risk factors, or optimal duration of hospitalization. The aim of this retrospective study is to find predictive factors in the clinical course of non-severe head trauma in children, and thus to determine an optimal management strategy. Poor clinical progress was observed in only 4 out of 113 children. When there are no clinical signs and no eating disorders, an earlier discharge is entirely appropriate. Nevertheless, persistent clinical symptoms including headache, vomiting, and late onset seizure, especially in conjunction with hemodynamic disorders such as bradycardia, present a risk of emergency neurosurgery or neurological deterioration. Special attention should be paid to extradural hematoma (EDH) of more than 10 mm, which can have the most severe consequences. Clinical aggravation does not necessarily correlate with a change in follow-up imaging. Conversely, an apparent increase in the brain lesion on the scan is not consistently linked to a pejorative outcome.

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“…There are some children with EDHs who are asymptomatic or minimally symptomatic with a relative small hematoma without compression to the brain. In these patients, a non-surgical approach is probably justified (Khan et al 2014). Some of these hematomas show spontaneous regression followed by absorption within 4-6 weeks post injury.…”

Section: Epidural Hematomasmentioning

confidence: 99%

Surgical Treatment of Severe Head Trauma

Eder

2020

Pediatric Surgery

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Conservative management of significant supratentorial epidural hematomas in pediatric patients

Cited by 19 publications

References 11 publications

Endovascular management of acute epidural hematomas: clinical experience with 80 cases

Endovascular management of acute epidural hematomas: clinical experience with 80 cases

Monitoring Criteria of Intracranial Lesions in Children Post Mild or Moderate Head Trauma

Surgical Treatment of Severe Head Trauma

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