Role of critical volume index in management of traumatic posterior fossa extradural hematoma

Abstract

Background: Posterior fossa extradural hematomas (EDH) constitutes 10% of all extradural hematomas. Before the emergence of CT scan; posterior fossa extradural hematomas were very difficult to diagnose based on clinical picture alone. Improvement in diagnostic methods, management protocols and treatment modalities have resulted in substantial reduction in mortality and morbidity and improvement in outcome.Methods: A prospective study was conducted in Government Rajaji Hospital, Madurai Medical College; Madurai attending trauma care centre; from January 2020 to December 2021 among 30 study subjects. 6 (20%) study subjects were excluded from the study. Study subjects diagnosed with traumatic posterior fossa EDH between 18-60 years were included in the study. After evaluation, the subjects were divided into three groups namely, Group I-conservative management 16 in 66.67% cases. Group II-initial surgical management 8 in 33.33% cases. Group III-initially planned for conservative then treated with surgery 5 in 20.83% cases.Results: Group I-GCS at admission was 13-15; 11 (68.75%) cases, 9-12; 4 (25%) cases and 3-8; 1 (6.25%) cases. Occipital bone fracture was noted in 14 in 87.5% cases. 9 in 56.25% cases had associated injuries. Total mortality was 1 in 6.25% case with GCS 3-8. Group II GCS at admission was 13-15; 1 in 12.5% case, 9-12; 5 in 62.5% cases, 3-8; 2 in 25% cases. All study subjects occipital bone fractures. Associated injuries seen in 4 in 50% cases. Mortality was seen in 3 in 37.5% study subjects. Group III- GCS after detoriation was 3-8 in 3 in 60% cases, 9-12 in 2 in 40% cases and 13-15 group had no study subjects. All study subjects had associated occipital bone fractures. Total mortality was seen in 3 in 60% cases. Equal distribution of shallow posterior fossa seen in all cases. Critical volume index is 0.032.Conclusions: Study subjects in the conservative group who have Initial GCS of 8 to 12; initial clot volume more than 8 ml; CVI more than 0.032 should undergo surgery as an initial management option in order to obtain better prognosis and outcome.