Surgical Outcome of Extradural Hematoma Patients in Relation to Preoperative Neurological Status

Abstract

Introduction: Epidural hematoma (EDH) is characterized by the acute onset of traumatic haemorrhage into potential space between the dura mater and skull following head injury. About 85% of the epidural cases are caused by skull fracture with rupture of the middle meningeal artery or its branches and rest of 1the time ruptured venous sinuses, fractured diploic bone. The BTF recommends that all patients with an EDH volume of greater than 30 cc should undergo surgical evacuation regardless of Glasgow Coma Scale (GCS). Aim of the Study: To assess the surgical outcome of extradural hematoma patients by using Glasgow Outcome Scale (GOS) postoperatively. Material & Methods: This prospective study was conducted in the Department of Neurosurgery, Dhaka Medical College and Hospital (DMCH), during the period of January 2016 to December 2017. A total of 98 patients of both sex and any age with EDH were selected purposively. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 22.0 for Windows (SPSS Inc., IBM and New York, USA). Prior to commencement of this study, the “Research Review Committee” & the “Ethical Committee” of DMCH, Dhaka, approved the research protocol. Results: In this study, 98 patients were included; they were divided into 6 groups. Age range was 04 - 55 years. It was observed that majority, 30 (30.60%) patients were from 21 - 30 years of age. The mean age was found 25.24 ± 12.2 years. Other age related distributions were shown in the table. Male patients were 78 (78.55%) and 22 (22.44%) patients were female. A male predominance was observed. Among admitting GCS 3-8, 56.25% patients had unfavorable outcome and 43.25% had favorable outcome. Admitting GCS 9-13, 2.5% patients had unfavorable outcome and 97.5% had favorable outcome. Admitting GCS 14-15, all patients (100.0%) had favorable outcome. Unfavorable outcome was observed in 9 (9.18%), 1 (1.00%) patients who belong 3-8, 9-13 GCS on admission. Mean GCS on admission was found 6.7 ± 2.44 score in unfavorable outcome group and 13.45 ± 2.30 score in favorable outcome group. Conclusion: This study revealed good surgical outcome in extradural hematoma patients. Preoperative GCS is an important predictor of outcome. Other preoperative neurological statuses like pupillary changes, neurological focal deficit, cranial nerve involvement, plantar reflexes and seizure also influence the surgical outcome.