Minimal Invasive Burr – Hole Management of Traumatic EDH

Abstract

Introduction: Epidural hematoma (EDH) is a neurosurgical emergency. Delay in urgent treatment may lead to severe morbidity and even mortality. Conventionally, EDH was treated by formal craniotomy. Rarely, minimally invasive burr – hole drainage is employed especially in critically sick patients. We believe every case of pediatric EDH can be successfully drained by minimally invasive burr – hole drainage.
Materials and Methods: This study was conducted at the Department of Pediatric Neurosurgery, The Children’s Hospital and the Institute of Child Health Lahore, between 19-01-2014 and 24-03-2016. The medical record of patients with EDH managed by minimally invasive burr – hole technique was reviewed in prospective way for history, clinical examination, investigations, management given, complications, and outcome.
Results: There were a total of 50 patients. Thirty four were male and 16 were female patients (M:F 2.1:1). Age was ranged between 45 days and 12 years (6.48yr ± 3.30yr). In 27 patients etiology of EDH was fall from roof and in 5 patients it was fall from bed/sofa, in 3 children fall from lap, in 8 fall from stairs, in 6 children it was road traffic accident, and brick fall over head in 1 child. Preoperative GCS was 3 – 8 in 11 patients, between 9 - 12 in 18, and between 13 – 15 in 21 patents. CT scan/MRI was performed in all patients for diagnosis, as per availability. All patients were operated by minimally invasive burr – hole drainage technique. Postoperatively, 1 patient required re-drainage by the same technique. There was one expiry in our series. All the 49 patients are discharged at GCS 15/15.
Conclusion: A survival rate of 98% is evident of safety and effectiveness of minimally invasive burr – hole drainage of EDH in children with added benefits of less operative time, operative morbidity, and hospital stay.