The Expectant Treatment of "Asymptomatic" Supratentorial Epidural Hematomas.
Chen, Tzu-Yung M.D.; Wong, Cheuk-Wah M.D.; Chang, Chen-Nen M.D.; Lui, Tai-Ngar M.D.; Cheng, Wan-Chun M.D.; Tsai, Ming-Dar M.D.; Lin, Tzu-Kang M.D.
32(2):176-179, February 1993.
SEVENTY-FOUR PATIENTS WITH a traumatic epidural hematoma (EDH) and a Glasgow Coma Scale score of more than 12 received expectant treatment; 14 subsequently underwent surgical evacuation of the EDH. A patient with initial brain computed tomograms (CT) showing an EDH volume of more than 30 ml, a thickness of more than 15 mm, and a midline shift beyond 5 mm tended to require surgery within 3 days of the injury when the brain had exhausted its compensatory mechanism and yielded to the expanding EDH. After the 3-day period, in the absence of neurological symptoms, the presence of the EDH may not be an indication for surgical evacuation or hospitalization beyond 7 days. In our patients, the presence of a skull fracture in the temporal bone, the heterogeneous density of the EDH in the CT scan, or the 6-hour period between the CT study and the injury did not significantly increase the failure rate of nonsurgical treatment. Although a zero mortality was achieved in this series, these guidelines may not be applicable to the management of an infratentorial EDH.
Copyright (C) by the Congress of Neurological Surgeons