Minimal Invasive Burr – Hole Management of Traumatic EDH
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.
2. Erşahin Y, Mutluer S, Güzelbag E. Extradural hema-toma: analysis of 146 cases. Childs Nerv Syst. 1993; 9: 96.
3. Servadei F. Prognostic factors in severely head injured adult patients with epidural haematomas. Acta Neuro-chir. 1997; 139: 273–8.
4. Rehman L, Khattak A, Naseer A, Mushtaq Outcome of acute traumatic extradural hematoma. J Coll Physicians Surg Pak. 2008; 18: 759–62.
5. Roka YB, Shah A. Post Traumatic Epidural Hematoma: Outcome Analysis in 68 Consecutive Unselected Cases. Nepal J Neurosc. 2010; 1: 6-9.
6. Petersen OF, Espersen JO. Extradural hematomas: mea-surement of size by volume summation on CT scann-ing. Neuroradiol. 1984; 26: 363-7.
7. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Et al. Surgical management of acute epi-dural hematomas. Neurosurg. 2006; 58: S2-7.
8. Mishra SS, Nanda N, Deo RC. Extradural hematoma in an infant of 8 months. J Pediatr Neurosci. 2011; 6: 158.
9. Khan IU, Nadeem M. There is high Incidence of skull fracture associated with extradural hematoma in pati-ents with head injury. Rawal Med J. 2008; 33: 228-30.
10. Rehman RU, Mushtaq MI, Azam F, Khattak A. Skull fracture on x-ray skull as an indicator of extradural hematoma in patients with head injury. Pak J Surg. 2012; 28: 106-9.
11. Islam MJ, Saha SK, Elahy MF, Islam KM, Ahamed SU. Factors influencing the outcome of patients with acute extradural haematomas undergoing surgery. Bangla-desh J Med Sci. 2011; 10: 112.
12. Umerani MS, Abbas A, Sharif S. Traumatic brain inju-ries: experience from a tertiary care centre in Pakistan. Turkish Neurosurg. 2013; 24: 19-24.
13. Ayub S, Rehman RU, Shah M, Khattak R, Ahmad M, Nabi A. Management outcome of extradural hematoma. Pak J Neurol Surg. 2014; 18: 17-20.
14. Haroon A, Khan ZM, Rehman AU, Majid, Vohra AH. Analysis of head injury patients and review of 100 cases of motor bike accidents. Pak. J Neurol Surg. 2014; 18: 8-12.
15. Figaji A. Intracranial and extracranial hematomas. In: Albright AL, Pollack IF, Adelson PD, editors. Princi-ples and practice of pediatric neurosurgery. 3rd ed. New York: Thieme, 2015: 718-28.
16. Aurangzeb A, Ahmed E, Maqbool S, Ihsan A, Ali A, Bhatti SN, et al. Burr hole evacuation of extradural hematoma in mass trauma. A life – saving and time saving procedure: our experience in the earthquake of 2005. Turk Neurosurg. 2016; 26: 205-8.
17. Liu JT, Tyan YS, Lee YK, Wank JT. Emergency man-agement of epidural haematoma through burr hole eva-cuation and drainage. A preliminary report. Acta Neu-rochir. 2006; 148: 313-7.
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