Surgical management of traumatic extradural haematoma: Experiences with 610 patients and prospective analysis

Abstract

This study was carried out to find out the age, sex, mode of injury, localization, clinical presentation, CT findings, operative measures and outcome of extradural haematoma in the patient population at Dhaka Medical College. 610 consecutive patients with cranial extradural haematoma who underwent surgery in department of Neurosurgery from 1st January 2006 to 6th October 2008 were included in this prospective study. Each of the patients were evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome. Out of 610 cases 86.32 % were male and 13.78 % were female. The male and female ratio was 6.27: 1. Age ranged from 2.5 to 83 years. Commonest age group was 21 to 30 years. Commonest mode of injury was Road traffic Accident 53.45%, followed by Assaults. Most common clinical presentation was headache / Vomiting 63.61 %, followed by altered sensorium 60.66 %. In this present prospective study of 610 cases of EDH, temporo parietal site was involved in 33.45 % followed by frontal region in 23.28 %. Sixty five patients (10.66 %) died; 19 of these had associated brain injuries and 28 cases were deeply unconscious. Extradural haematoma is a neurosurgical emergency where early surgical intervention is associated with the best prognosis. Many factors affects the outcome of extradural haematoma surgery and the most important one is the duration of time between incident/accident and operation in neurosurgical operation theater; mortality can be close to 0% if this time interval can be minimized.

The Initial Factors with Strong Predictive Value in Relation to Six-Month Outcome among Patients Operated due to Extra-Axial Hematomas

“…There is strong evidence that gender does not affect the prognosis in TBI [6,10,11]. In our study, gender was not placed among the factors which were significantly associated with the outcome after 6 months.…”

“…They came to similar conclusions [15,39]. Khaled et al investigated patients with EDH, and stated that the time between a trauma and a surgery is the most important prognostic factor, and shortening this time to a minimum can reduce mortality to zero [11]. Seelig et al based their study on patients undergoing surgery for SDH, and found that the surgery would reduce mortality from 90% to 30% within 4 h [40].…”

Correlation of Severe Head Injury Epidural Hematoma Trepanation Respond Time With Outcome

“…Bagaimanapun juga kejadian koma di antara pasien trauma lebih tinggi, yaitu sekitar 9% sampai 15%. 5 Hematoma epidural paling sering terjadi pada orang muda yang disebabkan karena kecelakaan lalu lintas (KLL). Pada dewasa muda insiden tertinggi terjadi pada kelompok umur 20-30 tahun, dan jarang terjadi pada umur di atas 60 tahun, hal ini disebabkan pada usia tua secara anatomis terdapat perlekatan antara duramater dan kranium.…”

Role of Computerized Tomography as Prime Imaging Modality in the Evaluation of Traumatic Brain Injury

“…According to Bullock et al, 21 patients who had EDH with thickness >15 mm, midline shift >5 mm should be surgically managed regardless of GCS score, and craniotomy provides a more complete evacuation of hematoma. Khaled et al 22 also found in their study that surgical intervention in EDH is associated with the best prog nosis. Out of many factors affecting the outcome, the most important one is the duration of time between accident and surgery; mortality can be close to 0% if this time interval can be minimized.…”