Traumatic Extradural Hematoma Research Articles

Evaluation of incidence and outcomes of compressive extradural haematoma-related infarcts in the paediatric population.

Traumatic extradural haematoma (EDH) is one of the neurosurgical emergencies in the paediatric population. One of the rare complications of extradural haematoma is adjacent parenchymal infarct from the compressive effect of haematoma leading to further morbidity. We aimed to evaluate the incidence and outcomes of this rare complication in paediatric trauma patients. We undertook a retrospective review of all operative extradural haematoma cases in single centre paediatric neurosurgical unit between the years 2008 and 2024. Cases with postoperative imaging were analysed for demographics, age, sex, dimensions of haematoma and underlying infarct, pre-operative GCS and pupillary abnormality and time interval from scan to surgery. Infarct was defined as well-defined parenchymal hypodensity corresponding to vascular territory and not attributable to contusions on postoperative CT head performed at 24-72 h. All patients suspected of stroke had further MRI brain for evaluation. Statistical analysis was then performed comparing groups with and without infarct. Overall, 115 cases of extradural haematoma were identified during the study period. Eighty cases had adequate postoperative imaging to allow assessment for infarcts; 7.5% demonstrated evidence of infarct underlying extradural haematoma. Mean age in the infarct group was 1.8 years (M:F ratio 2:1) with mean EDH dimensions of 77 mm × 31.4 mm × 79.7 mm). Mean age in the non-infarct group was 8.6 years (M:F ratio 2:1) with mean EDH dimensions of (57.5 mm × 19.6 mm × 62.6 mm). Children with infarcts were significantly younger with larger haematoma dimensions and hada higher proportion of pupillary abnormalities. There was no significant difference in pre-operative GCS and scan-to-surgery time-lapse between the groups with and without infarct. Compressive effect of EDH can lead to underlying parenchymal infarct. Children with extradural haematoma-related infarct were younger with larger haematoma size and a higher proportion of pupillary abnormalities.

Predictive Factors for Regression versus Progression of Nonevacuated Posttraumatic Acute Extradural Hematoma.

Study Design This study was a retrospective study conducted from October 2020 to October 2022 on 106 posttraumatic patients with acute extradural hematomas (EDHs) who were initially planned for conservative treatment. 74 patients had spontaneous EDH regression (EDHR), while 32 patients developed EDH progression (EDHP) and were shifted for surgery. The two groups were statistically compared regarding the different demographic, clinical, and radiographic factors to identify the significant predictors for regression versus progression of acute posttraumatic EDH. Objectives Conventionally, urgent evacuation is the accepted management for EDH. However, several recent reports have described successful conservative management in selected patients. There are no adequate clues to verify patients who will have spontaneous EDHR from those at risk for EDHP and delayed surgery. The main objective of this study was to identify the significant predictors for possible regression versus progression of acute posttraumatic EDH initially planned for nonsurgical treatment. Materials and Methods A retrospective study conducted over 2 years, included 106 head trauma patients with acute EDH, who were admitted to our department and were initially planned for conservative treatment. Various demographic, clinical, and radiographic factors were analyzed to verify the significant predictors for spontaneous EDHR (EDHR group) versus EDHP and subsequent surgical evacuation (EDHP group). Results The mean age was 20.37 ± 12.712 years and the mean Glasgow Coma Scale score (GCS) was 12.83 ± 2.113. Total 69.8% of patients showed spontaneous EDHR, while 30.2% developed EDHP and were shifted for surgical evacuation. Statistical comparison showed that higher GCS ( p = 0.002), frontal location ( p = 0.022), and concomitant fissure fracture ( p = 0.014) were the significant predictors for EDHR, while younger age ( p = 0.006), persistent nausea/vomiting ( p = 0.046), early computed tomography (CT) after trauma ( p = 0.021), temporal location ( p < 0.001), and coagulopathy ( p = 0.001) were significantly associated with EDHP. Conclusion Patients with traumatic EDH fitting the criteria of initial nonsurgical treatment necessitates 48 hours of close observation and serial CT scans at 6, 12, 24, and 48 hours to confirm the regression or early detect the EDHP. Patients with high GCS, frontal hematomas, and associated fissure fracture are at low risk for EDHP. Increased alertness is mandatory for young age and patients with persistent nausea/vomiting, early CT scan, temporal hematomas, or coagulopathy.

Impact of Time from Injury to Surgery on Postoperative Functional Recovery in Large Volume Traumatic Extradural Hematomas

Abstract Background In traumatic brain injury (TBI) patients, the time from trauma to cranial surgery is always of great concern to patients and neurosurgeons. Patients and Methods A retrospective study conducted on 93 TBI patients presented with Glasgow Coma Scale from 4 to 13 and were operated for large volume (≥ 40 cm3) extradural hematoma (EDH) from July 2020 to December 2022. Surgery was done either within 6 hours following trauma (group A) or later than 6 hours (group B). We evaluated the impact of time from injury to surgery on postoperative clinical recovery, survival, and hospital stay. Results Fifty patients (53.8%) were operated upon within 6 hours after trauma and 43 patients (46.2%) had operations later than 6 hours. No significant difference was found between the two study groups regarding any of the preoperative clinical or radiological factors except for the mean time from injury to surgery (p &lt; 0.001). Delayed surgery &gt; 6 hours was significantly associated with higher postoperative mortality (p = 0.014). Hospital stay was significantly shorter in patients operated ≤ 6 hours (p = 0.006). Patients operated ≤ 6 hours showed significantly favorable functional recovery both at discharge (p = 0.010) and after 1 month of follow-up (p = 0.023). Conclusion Timely surgical intervention for large volume traumatic EDH is the gold standard. Early surgery “within 6 hours from trauma” not only can save patients' life but also is significantly associated with postoperative favorable clinical recovery, low morbidity, and short hospital stay.

The Impact of Time till Surgery on Post-Operative Outcome of Traumatic Extradural Hematoma

Objective: Traumatic extradural hematoma (EDH) is a common complication of head injuries, predominantly affecting the working-age male population due to increased outdoor activity. This study aimed to assess the impact of timing in surgical intervention and identify factors influencing outcomes. Materials and Methods: Seventy-eight consecutive patients diagnosed with traumatic EDH at Lady Reading Hospital, Peshawar, were included. Patients were categorized into two groups based on the timing of presentation: within 6 hours (early) and after 6 hours (late). Craniotomy and hematoma evacuation were performed, and outcomes were assessed at discharge. Results: In our study mean and SDs for age were 21.83±31.57. Most of the patients i.e., 54(69.2%) were from the 2nd and 3rd decade of life. The mean hematoma volume was 37.17 ml. The majority of the patients were males 65(83.3%) and RTA 32(42.02%) was the most common cause followed by falls and physical assault respectively. The outcome of early operated (within 6 hours) patients was favorable in 44(95.65%) while 2 (4.34%) did not improve (GOS 2,3). Favorable outcomes (GOS 4,5) in delayed presented patients who operated after 6 hours were 23 (71.87%). 5(15.6%) were not improved (GOS 2,3) and 4(12.5%) died (GOS 1). Conclusion: Outcomes of patients who operated early are more favorable than those who were operated late. Delayed presentation and intervention increase the mortality and morbidity of patients having traumatic extradural hematoma.

Mortality And Prognostic Factors In Patients Operated For Acute Epidural Hematoma.

Epidural hematoma is one of the most common surgical emergencies encountered in neurosurgery. This study was conducted to determine the mortality and prognostic factors in patients operated for traumatic intracranial epidural hematoma in a resource-constrained setting from a developing country. This retrospective study was conducted in the Department of Neurosurgery at Ayub Teaching Hospital Abbottabad from 1st January 2019 to 31st Dec 2021. Inclusion and exclusion criteria were created. The medical record of 116 patients admitted and operated on for traumatic extradural hematoma was retrospectively reviewed. Information was recorded using a standardized structured questionnaire. The outcome was measured in terms of the Glasgow coma outcome score. Out of 116 patients, 93 were male and 23 were female.19 (16.4%) patients were in the age range 0-5 years, 42 (36.2%) were in the age range 6-15, 35(31.0%) were in the age range 16-30, 11 (9.5%) were in the age range 31-45 years, 7 (6.0%) were in the age range 46-60 years while only one patient included in this study was above 60 years. Overall mortality was 4.3%. Mortality was higher in females and in those aged less than 5 years (3.4%). 4 out of 16 patients died with GCS less than 8, while none of the patients died when GCS was above 12. Mortality was significantly higher in the presence of associated lesions (4.4% vs. 0%) and anisocoria (2.6% vs.1.7%). Patients who operated within 6 hours of trauma resulted in better outcomes with a mortality rate of 0.0% and functional recovery of 57.8 % while for those who operated after 6 hours, mortality was significantly higher (4.3%) and functional recovery was significantly low (15.5%). Good surgical outcomes can be achieved with early operative intervention if indicated. Female gender, low preoperative GCS score, presence of pupillary dilatation, presence of associated lesions, delayed surgical intervention and age less than 5 years are significant predictors for poor outcomes.

Impact of perioperative factors on short-term outcomes after emergency surgery for acute traumatic extradural hematoma – A retrospective cohort study

BackgroundPreoperative clinical and imaging findings predict neurological outcomes in patients with traumatic brain injury (TBI). Similarly, intraoperative factors such as blood loss and hypotension can also affect outcomes. However, there is not much data regarding the influence of perioperative variables on clinical outcomes in patients with extradural hematoma (EDH). This study aimed to understand the effect of perioperative factors on short-term neurological outcomes in patients operated for acute traumatic EDH. MethodsAfter obtaining institutional ethical approval, we collected data retrospectively from records of patients who underwent emergency surgery for acute traumatic EDH over a two-year period. Data regarding age, gender, preoperative Glasgow coma scale (GCS) score, clinical and imaging findings, surgical and anesthetic details, blood loss and transfusion, duration of hospital stay, and GCS score at discharge were collected. Patients with discharge GCS score of 14–15 were considered to have favorable outcome and <14 as unfavorable outcome. Regression analysis was performed to examine the association between predictors and outcomes. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated. ResultsData of 501 patients were analyzed. Outcome was favorable in 343 (68.5 %) and unfavorable in 158 (31.5 %) patients. On multivariate logistic regression analysis (OR, 95 % CI, p value), age (1.03, 1.01–1.05, 0.01), preoperative GCS score (0.68, 0.61–0.76, <0.001), signs of basal skull fracture (1.9, 1.02–3.61, 0.043) and intraoperative blood loss (2.23, 1.2–4.16, 0.01) were independently associated with unfavorable outcome. Pneumonia, neurological deficits, inotrope use and duration of hospital stay was more in this group. ConclusionsOlder age, poor pre-operative GCS score, signs of basal skull fracture, and intraoperative blood loss were associated with lower discharge GCS score, increased neurological deficits and longer hospital stay in patients operated for acute traumatic EDH.

Assessment of outcome in surgically treated traumatic extradural haematoma patients

In approximately 2% of all patients with head injuries, Extradural haematoma occurs. Immediate diagnosis and surgical evacuation is usually required. Outcome in patient with EDH can be assessed using Glasgow outcome score (GOS). Five parameters of outcome we have measured in our study are - good recovery, moderate disability, severe disability, vegetative state and death.Assessment of outcome of patient by using Glasgow outcome score (GOS) and assessing the outcome with respect to the initial GCS at admission was done.Most (51.42%) of the patients were in the age group of 16-31 years. RTA was the most common (51.42%) cause for EDH occurrence. Most of the patients (57.14%) had GCS of 13-15 in our study. Majority of the patients (68.57%) had a Glasgow outcome score of 5, indicating a good outcome. 51.42% of patients having a GCS of 13-15 had a good outcome, whereas 11.42% of patients having GCS of 9-12 and 5.71% of patients having GCS of ≤ 8 had good outcome.EDH is one of the most serious complications in head injury. It requires immediate diagnosis and management. Urgent surgical intervention improves the outcome Mild head injury patients (GCS 13-15) have good outcome (GOS 5) as compared to with severe head injury (GCS ≤ 8) patients. Lower GCS patients have poor outcome.

Anaesthetic management of right tibia intramedullary nailing in a patient with extradural haematoma

Cases of extradural haematoma (EDH) are often encountered in the emergency department in patients with multiple traumatic injuries. If the haematoma is small, non-expanding and asymptomatic, it is often managed conservatively. However, other injuries sustained during trauma may require surgical intervention, during which anaesthetic management can become challenging. Here, we present a case where closed reduction and intramedullary nailing was done for a right tibia fracture, successfully performed in a patient with traumatic EDH under combined femoral and popliteal sciatic nerve block with supplementary dexmedetomidine infusion for sedation.

Frequency of Delayed Onset of Traumatic Extradural Hematoma in Patients Presenting with Head Injuries

Objective: To assess the frequency of delayed traumatic extradural hematoma in patients presenting with head injuries in emergency of a tertiary care hospital. Materials and Methods: In this case series a total 125 patients who presented with head injury were included. All patients underwent assessment on Glasgow Coma Scale (GCS) and score was noted at baseline. Then patients were managed according to hospital protocol. After procedure, patients were shifted to post-surgical ward and were followed-up for 5 days. After 3 and 5 days, CT scan was done to assess presence or absence of extradural hematoma. Results: Mean age of patients in this study was 34.53±10.82 years. In this study 86 (68.8%) patients were male and 39 (31.2%) patients were female. In this study, 20 (16%) patients had delayed onset of Traumatic extradural hematoma in patients presenting with head injuries. DEDH was diagnosed in 45% patients having age 20-30 years, in 35% patients having age 31-40 years and in 20% patients having age &gt;40 years. DEDH was diagnosed in 13 (65%) patients having baseline GCS 11-12, in 20% patients having GCS 8-10, in 15% patients having GCS 13-14. Conclusion: In this study frequency of delayed onset of Traumatic extradural hematoma in patients presenting with head injuries was 16%. Highest frequency (45%) was seen in the younger age group; 20-30 years, among male (65%) patients and those having baseline GCS in the range 11-12 (65%). Keywords: Traumatic extradural hematoma, delayed onset, head injury.

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

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.

Role of non operative management of extradural hematoma and reasons for conversion in patients admitted in tertiary care hospital in Bihar

Background: A patient with traumatic extradural hematoma may be managed conservatively, but constant monitoring is recommended because neurological impairment might progress suddenly. Aim: The goal of our research was to look into the role of conservative management in traumatic extradural hematoma as well as the various reasons for conversion in patients admitted in tertiary care hospital in Bihar. Methods and Materials: Patients with EDH were divided into two groups. Group-A: those who needed the hematoma surgically removed right away. Group B was subdivided into two subgroups: B1- Individuals who were given conservative treatment. B2 - Individuals who responded well to conservative treatment despite the presence of EDH on its first CT scan and who required surgery during conservative management due to various reasons like neurodeterioration. Complete evaluations were carried out for other factors for conversion of non surgical management into surgical management. Results: In this study a total of 120 patients were evaluated. 31 patients were managed by surgery. 69 patients were managed conservatively. 20 patients were there in which conversion from conservative management to surgical management took place.

Compare the Outcome of Surgical Versus Conservative Treatment of Traumatic Extradural Hematoma in the Supratentoral Region

Objective: Aim of current study is to determine and compare the outcomes of surgical versus conservative treatment of traumatic extradural hematoma in the supratentoral region. Study Design: Prospective/ Randomized study Place and Duration: Conducted at Neurosurgery department of Bacha khan Medical College / Mardan Medical Complex Mardan and Frontier Medical and Dental College Abbottabad for duration of six months from April 2021 to September 2021. Methods: There were one hundred and eight patients of both genders with ages 14-55 years were included. Included patients had traumatic extradural hematoma in the supratentoral region. Demographically detailed included cause of trauma, age and gender were calculated after taking informed written consent. CT scan was performed among all the patients to diagnose hematoma. Patients were equally categorized into two groups. Group I received surgical treatment and group II received conservative treatment. Symptoms and complications among both groups were assessed. Glasgow comma score was used. Post treatment outcomes were compared among both groups by using t-test. We used SPSS 21.0 version to analyze complete data. Results: Among 54 patients in group I 31 (57.4%) cases were males and 23 (42.6%) patients were females and in group II 35 (64.8%) were male patients and 19 (35.2%) females. Majority of the patients 65 (60.2%) among both groups were in age group 21-35 years followed by 14-20 years 30 (27.8%) cases. Road traffic accident was the most common cause found in 27 (50%) and 29 (53.7%) in groups I and II. Consciousness loss, vomiting and headache were the most common symptoms. Mean hematoma volume in group I was 29.11±6.38 ml and in group II 22.16±8.47 ml. Mean GCS in group I was 15.07±3.13 and in group II was 16.18±5.38. We found that conservative treatment presented favorable outcomes 53 (98.4%) as compared to surgical treatment in 50 (92.6%) cases. No any mortality found in this study. Conclusion: We concluded in this study that the conservative for the extradural hematoma in supratentoral region was effective and safe treatment as compared to surgical. Most common cause was RTA. There is no any mortality found in both treatments. Keywords: Supratentoral Region, Extradural hematoma, GCS, Outcomes

Determine the Outcome of Traumatic Extradural Hematoma and to Compare the Outcome of Small and Large Size Extradural Hematoma

Objective: The aim of this study is to determine the outcome of traumatic extradural hematoma and to compare the outcome of small and large size extradural hematoma. Study Design: Descriptive case study Place and Duration: Study was conducted at the department of Neurosurgery, Saidu Teaching Hospital, Saidu Sharif, Swat for duration of two years from January 2016 to December 2017. Methods: Total one hundred and forty patients of both genders with ages 2-70 years were presented. Patients had traumatic extradural hematoma within duration first 24 hours were included and admitted through the emergency department. Detailed demographics of enrolled cases age, sex, GCS on arrival and cause of injury were recorded after taking informed written consent. CT scan of all the patients was done for diagnosis. Glasgow Outcome Score (GOS) was used for determination of outcomes. SPSS 23.0 version was used to analyze the data. Results: There were 110 (78.6%) male patients and 30 (21.4%) patients were females. Mean age of the patients was 32.78±10.43 years. RTA was the most common cause found in 84 (60%) followed by falling 29 (20.7%) and assault in 27 (19.3%). Small size hematoma volume among 100 (71.4%) cases and large size was in 40 (28.6%) patients. According to Glasgow outcome score, 24 (17.1%) cases had 1-3 score and 116 (82.9%) cases had 4-5 score. Mean GOS was 4.01±1.12. We found successful outcomes among 116 (82.9%) cases in which majority of the patients were from small size extradural hematoma. Conclusion: We concluded in this study that a significant relationship exists between the volume of extradural hematoma and both the clinical and functional outcome. Prognosis becomes increasingly worse with rising extradural hematoma size. Keywords: Traumatic Brain Injury, Extradural Hematoma, Glasgow Outcome Score

Comparison of Surgical versus Conservative Management of Borderline Traumatic Extradural Hematomas Without Neurological Deficit

Objective: To compare the outcome of surgical versus conservative treatment of traumatic extradural hematoma in the supratentorial regin.&#x0D; 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.&#x0D; 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.&#x0D; Conclusion: Both surgical and conservative treatments are equally effective in terms of a favorable outcome and mortality occurrence in management of traumatic EDH &lt;30ml without neurological deficit. The conservative treatment is safe and cost-effective in borderline patients.

Outcome of the Traumatic Extradural Hematoma on the Basis of Size of Extradural Hematoma

Objective: This study aimed to determine the outcome of traumatic extradural hematoma and to compare the outcome of small and large size extradural hematoma.&#x0D; Materials &amp; Methods: A descriptive case series was carried out in the Department of Neurosurgery, Hayatabad Medical Complex Peshawar for six months and included 188 patients. The detailed history and clinical examinations were noted through a pre-designed proforma. Patients were followed post-operatively till the time of discharge and for either favorable outcome or unfavorable outcome according to the GOS.&#x0D; Results: 73% of patients had extradural hematoma volume between 25 – 50 mL, while 27% patients had extradural hematoma &gt;50 mL. 12% of patients had Glasgow Outcome Score (GOS) scores 1 – 3, while 88% of patients had GOS scores: 4 – 5. The mean GOS was 3. Patients with favorable outcomes were 88% while 12% had an unfavorable outcome.&#x0D; Conclusion: The size of the extradural hematoma has a strong correlation with outcome. The greater the size of the hematoma, the poorer the outcome.

Clinico-radiological Correlation with Outcome in Traumatic Pediatric Extradural Hematoma: A Single Institutional Experience.

ABSTRACTBackground:Head injury is one of the leading causes of mortality and morbidity in the developing as well as developed countries. Extradural hematoma is seen in 1–2% of cases of head injury patients. Extradural hematoma is infrequent in the pediatric age group (less than 18 years) as duramater is tightly adherent to the inner table of the skull and is present in about 1–3% of all pediatric head injuries.Materials and Methods:The study was a prospective study conducted in the Department of Neurosurgery at PGIMER, Dr. RML Hospital, New Delhi, over a period of 19 months with a follow-up of 6 months. In total, 38 patients were enrolled in the study. All traumatic extradural hematoma below 18 years of age of both sexes were included. Follow-up of all patients was done at 2 weeks, 1, 2, and 6 months. Noncontrast computed tomography (NCCT) head was done in all patients at the time of admission and whenever their neurological status deteriorated. Routine postoperative NCCT head was done. Outcome assessment was done by Glasgow outcome scale.Results:Of the 38 children, 21 were males and 17 were females. The maximum number of patients was between the ages of 1–5 years (55.26%). Fall from height was the most common cause. Loss of consciousness was the most common presenting symptom (78.94%). Thirty-three patients had GCS of 14–15 at the time of presentation. The parietal region was the most common location of EDH in our study (44.74%). Thirty-five patients had supratentorial and three patients had infratentorial EDH. Eighteen patients had associated brain injury, commonest being brain edema. Six patients were operated. There was no mortality in our study. Two patients had limb paresis.Conclusion:Pediatric EDH is a rare entity but a potentially life-threatening condition. Prompt diagnosis and timely intervention decrease morbidity and mortality.

Favourable Outcome in Pediatric Neurosurgery for Extra Dural Hematoma in Sub Sahara Africa: Report of Parakou University Hospital in the Benin Republic

Introduction The extra dural hematoma is a blood collection between the cranial vault and the dura mater. It is a neurosurgical emergency whose statistical data are poorly known in the Republic of Benin. Objective The aims of this study are to assess epidemiology, therapeutic and outcome of traumatic extra dural hematomas for children admitted to the surgical department of CHUD-B/A from 2012 to 2017. Methods This was a cross-sectional, descriptive and retrospective study over a period from January 1st, 2012 to December 31st, 2017. Results One hundred and seventy-eight cases of children aged between 0-15 years were examined for brain traumatic injury. Twenty-seven 27 (15.2%) cases of extra dural hematomas were retained. The most represented age group was between 11-15 years with a frequency of 42.1%. The male sex was more represented (78.9%). Road traffic accidents were the main aetiology (57.9%). 52.6% had a mild head injury, 26.3% had a moderate head injury and 21.1% had a severe head injury. On brain scan the frequently observed location was temporo-parietal (31.6%). Acute anemia was observed in 16 children. Seventeen children were operated on. The operation involved evacuation of extra dural hematoma by cranial bone flap with suspension of the dura mater. There were no deaths. Conclusion The availability of brain CT makes the diagnosis of extra dural hematoma easier. Its management is neurosurgical with a favourable post-operative evolution in all cases in this series.

Extradural hematoma: Experience in achieving zero mortality of children patient in a single center

Introduction: Extradural hematoma (EDH), a common sequela of traumatic brain injury, can lead to mortality and disability if there is a delay in identifying the pathology and subsequent management. In the 1920s, the mortality rate was reported as 86% and improved to 10% over the new millennium. We review our EDH cases to identify how we achieved zero mortality, which is the ultimate goal of EDH management.Methods: We retrospectively reviewed all traumatic EDH cases seen in the specialized pediatric neurosurgery department of Sabah Women &amp; Children Hospital from January 2013 to August 2018. Patients’ case records, operative notes and radiological images were tracked and reviewed. A total of 101 cases were identified.Results: We had 101 patients ranging from the age of 9 months to 12 years. Fifty-eight patients (58.41%) were males, and 42 were females (41.59%). A total of 37 patients (36.3%) were treated surgically, and 64 patients (63.7%) were treated conservatively. About 92 patients (91.09%) presented with supratentorial EDH and 9 patients (8.91%) had infratentorial EDH. Skull fractures were present in 47 children (46.5%). In the pediatric age group, fall from heights was the most common cause. We achieved zero mortality among our patients who were treated both surgically and conservatively.Conclusion: EDH is a neurotrauma emergency that can be lethal, yet it is the most rewardingly responsive lesions treated by neurosurgeons. Early diagnosis, prompt referrals, early surgical intervention when indicated, and good intensive care remain the paramount facets towards achieving zero mortality in EDH. This study proves that our results are comparable to those seen in other neurosurgical centers throughout the developed world. An institutional protocol for EDH may ensure that the ultimate goal of towards ‘zero mortality’ could be achieved systematically and consistently.Keywords: conservative, extradural hematoma, pediatric, surgical, zero mortality

The outcome of observation of acute traumatic extradural hemorrhage in pediatric age group.

The non-operative management of extradural hemorrhage in the pediatric age group has been increasingly considered in the last decade with good clinical outcomes and comparable results to surgical intervention in carefully selected patients. The purpose of this study is to evaluate the outcome of observation in the management of pediatric patients with extra dural hematoma. All consecutive pediatric patients with traumatic EDH after TBI who were presented to a single neurosurgical institution between January, 2008 and November, 2018 were retrospectively reviewed. Mechanism of injury, Glasgow coma scale (GCS) on admission, presenting neurological examination, treatment modality, the first and last imaging findings, and outcome were analyzed. The outcome was measured using the Glasgow outcome scale (GOS) on discharge from the hospital. A total of 83 patients were identified. The median age was 7.1years (0.8-14years) and 67% of the patients were male (n = 56). The median thickness of acute EDH was 1.1cm (0.2-2.6cm). 44 patients were managed conservatively with a close observation at a specialized neurotrauma unit for any clinical deterioration, and the remaining 39 patients were managed surgically. There was no significant difference in the patients age, hematoma thickness, presence of skull fractures, systemic injuries, and other types of cerebral injuries between the two groups. The presenting GCS was significantly lower in the surgical group which reflects the severity of the injury. Hospital stay was significantly longer among the surgical group, and the GOS was significantly better in the non-surgical group. The majority of the surgical group showed complete resolution of the hematoma on discharge, while only 50% of the non-surgical patients (n = 22) had a complete resolution of the hematoma one month after the TBI. The conservative management is applicable in carefully selected pediatric patients with acute traumatic extradural hematoma provided that the observation is accomplished in a well-established and equipped neurosurgical unit. These results are congruent with similar earlier studies.

Clinico-radiological correlation with outcome in EDH in paediatric age group -a two year study in a tertiary care hospital

Introduction: Aim of the study was to assess the correlation between clinico -radiological features with outcome in traumatic extradural hematoma in paediatric age group at a tertiary care hospital in Kolkata. Materials and Methods: Total of 47 cases of traumatic paediatric extradural hematoma were analysed prospectively for the period of two years to find out the clinic-radiological pattern with outcome in study group patients. Results: Maximum number of patients were between 1-5 years (55.32%) and male patients slightly outnumbered female (55.32% male vs 44.68% female). Loss of consciousness was the most common clinical presentation. Pretreatment GCS score was found to be directly related to the speed of recovery and outcome. Those in whom there were other associated intracranial injuries showed relatively poor recovery. No sex difference was seen in outcome. Location and volume of EDH did not seem to influence the outcome. Conclusion: Traumatic extradural hematoma in children is an uncommon trauma sequel. Most commonly EDH in children is due to fall from height and Road traffic accident. Classical presentation with lucid interval is uncommon and has no direct effect on outcome. Associated intracranial injuries are common and affect outcome. EDH volume itself does not affect the outcome if timely intervention is done. GCS score at presentation is the most important factor determining the outcome. Keywords: Extradural Hematoma (EDH), Paediatric Age Group, Traumatic