<- Home <- Arhive <- Vol. 22, Issue 1, March 2014

Rom J Leg Med22(1)45-50(2014)
© Romanian Society of Legal Medicine

Extradural hematoma – is surgery always mandatory?

L. Tataranu, V. Ciubotaru, D. Paunescu, A. Spatariu, M. Radoi

Abstract: Although surgery remains the treatment of choice for extradural hematomas (EDH), there were many cases reported in the literature with good outcome, even if they were not treated surgically. The aim of this study was to discover the most important factors influencing the management strategy and outcome of EDH and to outline a set of guidelines for the treatment. Fifty-six consecutive adult patients treated for EDH between 2008 and 2012 formed the base of this retrospective study. The patients were treated as follows: 28 cases (50.0%) underwent urgent surgery, 13 cases (23.2%) were managed nonoperatively and 15 cases (26.8%) required delayed surgery. The conservative management was directly related to the volume of the EDH, and the EDH volume over 30 cm3 was a significant prognostic factor for conversion to surgery (95 % CI, p < 0.001). Patients in coma (Glasgow Coma Score < 8) have a poorer outcome than patients in good neurological status, regardless of to the therapy followed (95% CI, p = 0.0034). The volume of the EDH was not demonstrated to be a prognostic factor related to outcome (95 % CI, p = 0.2031). In conclusion, the diagnosis of the EDH must be promptly made by CT scan and the patient should be handled as an emergency and admitted into a neurosurgical center. Surgical indications mainly rely on the patient’s neurological status and CT findings.
Keywords: extradural hematoma, brain injury, outcome.

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