Comparison of Surgical versus Conservative Management of Borderline Traumatic Extradural Hematomas Without Neurological Deficit
DOI:
https://doi.org/10.36552/pjns.v25i2.543Keywords:
Mortality, Conservative, Traumatic Extradural HematomaAbstract
Objective: To compare the outcome of surgical versus conservative treatment of traumatic extradural hematoma in the supratentorial regin.
Material and Methods: It was a prospective randomized controlled trial conducted in Departments of Neurosurgery, Allied Hospitals, Faisalabad between December 2019 to November, 2020. A total of 100 patients Supratentorial EDH; fulfilling the selection criteria were enrolled. All patients underwent clinical and radiological assessment of EDH volume by the same neurosurgical team. The patients were then divided randomly into two groups by using the lottery methods. Group A patients were conservatively managed. Group B underwent surgery. All surgeries were done by the same surgical team. Glasgow outcome scale was noted in 5 days after admission or surgery in both groups.
Results: The patients average age was 29.96 years, male to female ratio was 1.7:1. The mean volume of hematoma was 24.68 and 27.56 in group A (conservative group) and Group B (operated group) respectively. The favorable outcome was noted in all the patients and no mortality occurred in any patients.
Conclusion: Both surgical and conservative treatments are equally effective in terms of a favorable outcome and mortality occurrence in management of traumatic EDH <30ml without neurological deficit. The conservative treatment is safe and cost-effective in borderline patients.
References
2. Bae DH, Choi KS, Yi HJ, Chun HJ, Ko Y, Bak KH. Cerebral infarction after traumatic brain injury: incidence and risk factors. Korean Journal of Neurotrauma, 2014; 10 (2): 35.
3. Kang J, Hong S, Hu C, Pyen J, Whang K, Cho S, Kim J, Kim S, Oh J. Clinical analysis of delayed surgical epidural hematoma. Korean Journal of Neurotrauma, 2015; 11 (2): 112.
4. Khan MA, ANWAR M, AKMAL M, Ashraf N, Mahmood K. Conservative Management of Extradural Hematoma in Minor Head Injury. Pakistan Journal of Neurological Surgery, 2013; 17 (2): 156-60.
5. Bhau KS, Bhau SS, Dhar S, Kachroo SL, Babu ML, Chrungoo RK. Traumatic extradural hematoma—role of non-surgical management and reasons for conversion. Indian Journal of Surgery, 2010; 72 (2): 124-9.
6. Bhau KS, Bhau SS, Dhar S, Kachroo SL, Babu ML, Chrungoo RK. Traumatic extradural hematoma—role of non-surgical management and reasons for conversion. Indian Journal of Surgery, 2010; 72 (2): 124-9.
7. Binder H, Majdan M, Tiefenboeck TM, Fochtmann A, Michel M, Hajdu S, Mauritz W, Leitgeb J. Management and outcome of traumatic epidural hematoma in 41 infants and children from a single center. Orthopaedics & Traumatology: Surgery & Research, 2016; 102 (6): 769-74.
8. Basamh M, Robert A, Lamoureux J, Saluja RS, Marcoux J. Epidural hematoma treated conservatively: when to expect the worst. Canadian Journal of Neurological Sciences, 2016; 43 (1): 74-81.
9. Tallon JM, Ackroyd-Stolarz S, Karim SA, Clarke DB. The epidemiology of surgically treated acute subdural and epidural hematomas in patients with head injuries: a population-based study. Canadian Journal of surgery, 2008; 51 (5): 339.
10. Dolgun H, Türko?lu E, Kertmen H, Y?lmaz ER, Ergun BR, Sekerci Z. Rapid resolution of acute epidural hematoma: case report and review of the literature. Ulus Travma Acil Cerrahi Derg. 2011; 17 (3): 283-5.
11. Negishi H, Lee Y, Itoh K, Suzuki J, Nishino M, Takada S, Yamasaki S. Nonsurgical management of epidural hematoma in neonates. Pediatric Neurology, 1989; 5 (4): 253-6.
12. Bullock R, Smith RM, Van Dellen JR. Nonoperative management of extradural hematoma. Neurosurgery, 1985; 16 (5): 602-6.
13. Dubey A, Pillai SV, Kolluri SV. Does volume of extradural hematoma influence management strategy and outcome? Neurology India, 2004; 52 (4): 443.
14. Pozzati E, Tognetti F. Spontaneous healing of acute extradural hematomas: study of twenty-two cases. Neurosurgery, 1986; 18 (6): 696-700.
15. Weaver D, Pobereskin L, Jane JA. Spontaneous resolution of epidural hematomas: Report of two cases. Journal of Neurosurgery, 1981; 54 (2): 248-51.
16. Zakaria Z, Kaliaperumal C, Kaar G, O'Sullivan M, Marks C. Extradural haematoma—to evacuate or not? Revisiting treatment guidelines. Clinical Neurology and Neurosurgery, 2013; 115 (8): 1201-5.
17. Chen TY, Wong CW, Chang CN, Lui TN, Cheng WC, Tsai MD, Lin TK. The expectant treatment of “asymptomatic” supratentorial epidural hematomas. Neurosurgery, 1993; 32 (2): 176-9.
Downloads
Published
Issue
Section
License
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
