Single Burr Hole Evacuation of Extradural Hematoma in Pediatric Population: An Experience from the Biggest Children Hospital of Pakistan

  • Mian Awais The Children’s Hospital & The Institute of Child Health, Lahore
  • Akhtar Muner The Children’s Hospital & The Institute of Child Health, Lahore
  • Lubna Ijaz The Children’s Hospital & The Institute of Child Health, Lahore
  • Laeeq-ur- Rehman The Children’s Hospital & The Institute of Child Health, Lahore
  • Ubaid-ur- Rahman
  • Rimla Ayesha Mujahid Hospital, Faisalabad – Pakistan
Keywords: Extradural Hematoma, Burr Hole, Computed Tomography

Abstract

Objective:  To observe the outcome of single burr hole evacuation of EDH in a pediatric population.

Material and Methods:  We included 52 children who had had a head injury and were diagnosed with EDH on a CT scan. Over three months, they were all admitted to the pediatric neurosurgery ward. Serial CT scans and neurological evaluations were performed on all of the youngsters regularly to monitor their progress.

Results:  52 pediatric and adolescent patients were included. The age range was 6 months to 18 years. There were 30 male and 22 female patients. All of the children have EDH as a result of head injuries sustained in various accidents. All of the youngsters underwent surgery to remove EDH through a single burr hole. On the second postoperative day, five infants underwent reoperation owing to neurological deterioration, and two children died. The result was good (mRS 0) in 44/52 (84.6%) instances, mild deficits (mRS 1–2) in 4/52 (7.6%), and severe impairments (mRS 3–5) in 2/52 (3.84%) cases six months after the event.

Conclusion: Although, EDH is a life-threatening surgical disease if not treated promptly, EDH evacuation by a single burr hole has a satisfactory prognosis in the juvenile population, with fewer complications and recurrences.

References

1. Ammirati M, Tomita T. Posterior fossa epidural hematoma during childhood. Neurosurgery, 1984; 14: 541–4.
2. Carcassonne M, Choux M, Grisoli F. Extradural hematomas in infants. J Pediatr Surg. 1977; 12: 69–73.
3. dos Santos AL, Plese JP, CiquiniJúnior O, Shu EB, Manreza LA, Marino Júnior R. Extradural hematomas in children. Pediatr Neurosurg. 1994; 21: 50–4.
4. Gallagher JP, Browder EJ. Extradural hematoma. Experience with 167 patients. J Neurosurg. 1968; 29: 1–12.
5. Mazza C, Pasqualin A, Feriotti G, Da Pian R. Traumatic extradural haematomas in children: experience with 62 cases. Acta Neurochir. 1982; 65: 67–80.
6. Parslow RC, Morris KP, Tasker RC, Forsyth RJ, Hawley CA. Epidemiology of traumatic brain injury in children receiving intensive care in the UK. UK Paediatric Traumatic Brain Injury Study Steering Group; Paediatric Intensive Care Society Study Group. Arch Dis Child, 2005; 90: 1182–1187.
7. Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC: Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med. 1981; 304: 1511–8.
8. Jamieson RG, Yelland JDN: Extradural hematoma: report of 167 cases. J Neurosurg. 1968; 29: 13–23.
9. Lobato RD, Rivas JJ, Cordobes F, et al: Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg. 1988; 68: 48–57.
10. McKissock W, Taylor JC, Bloom WH, Till K: Extradural haematoma: observation on 125 cases. Lancet, 1960; 2: 167–72.
11. McLaurin RL, Ford LE: Extradural hematoma: statistical report of 47 cases. J Neurosurg. 1964; 21: 364–71.
12. Marshall LF, Gautille T, Klauber MR, et al. The outcome of severe closed head injury. J Neurosurg. 1991; 75: S28–S36.
13. Wilberger JE, Harris M, Diamond DL. Acute subdural hematoma: morbidity and mortality related to timing of operative intervention. J Trauma, 1990; 30: 733–6.
14. Gutman MB, Moulton RJ, Sullivan I, Hotz G, Tucker WS, Muller PJ: Risk factors predicting operable intracranial hematomas in head injury. J Neurosurg. 1992; 77: 9–14.
15. Kaufman HH, Makela ME, Lee KF, Haid RW, Gildenberg PL. Gunshot wounds to the head: a perspective. Neurosurgery, 1986; 18: 689–95.
16. Nehls DG, Mendelow AD, Graham DI, Teasdale GM. Experimental intracerebral hemorrhage: early removal of a spontaneous mass lesion improves
late outcome. Neurosurgery, 1990; 27: 674–82
17. Seelig JM, Marshall LF, Toutant SM, et al. Traumatic acute epidural hematoma: unrecognized high lethality in comatose patients. Neurosurgery, 1984; 15: 617–9.
18. Balmer B, Boltshauser E, Altermatt S, Gobet R. Conservative management of significant epidural haematomas in children. Childs Nerv Syst. 2006; 22: 363–7.
19. Ersahin Y, Mutluer S, Güzelbag E. Extradural hematoma: analysis of 146 cases. Childs Nerv Syst. 1993; 9: 96–9.
20. Gerlach R, Dittrich S, Schneider W, Ackermann H, Seifert V, Kieslich M. Traumatic epidural hematomas in children and adolescents: outcome analysis in 39 consecutive unselected cases. Pediatr Emerg Care, 2009; 25: 164–9.
21. Stieg PE, Kase CS. Intracranial hemorrhage: diagnosis and emergency management. Neurol Clin. 1998; 16: 373–90.
22. Agrawal A, Agrawal CS, Kumar A, Adhikari S: Outcome of traumatic extradural haematoma managed surgically: Our experience. NJOT. 2007; 6 (2): 74-76,
23. Husain M, Ojha BK, Chandra AM, Singh A, Singh G, Chugh A, Rastogi M, Singh K: Contralateral motor deficit in extradural hematoma: Analysis of 35 Patients. Indian Journal of Neurotrauma (IJNT), 2007; 4 (1): 41-44,
24. Pasaoglu A, Orhon C, Koc K, Selcuklu A, Akdemir H, Uzunoglu H. Traumatic extradural haematomas in pediatric age group. Acta Neurochir. 1990; 106: 136–9.
25. Beni-Adani L, Flores I, Spektor S, Umansky F, Constantini S. Epidural hematoma in infants: a different entity? J Trauma Acute Care Surg. 1999; 46: 306–11.
26. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW. Surgical management of acute epidural hematomas. Neurosurgery, 2006; 58 (Suppl. 3): 7–15.
Published
2021-09-30
Section
Original Articles