The expectant treatment of “asymptomatic” supratentorial epidural hematomas

Tzu Yung Chen, Cheuk Wah Wong, Chen Nen Chang, Tai Ngar Lui, Wan Chun Cheng, Ming Dar Tsai, Tzu Kang Lin

Research output: Contribution to journalArticlepeer-review

69 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)176-179
Number of pages4
JournalNeurosurgery
Volume32
Issue number2
DOIs
Publication statusPublished - Feb 1993

Keywords

  • Computed tomograms
  • Epidural hematoma
  • Expectant treatment
  • Head injury
  • Hospitalization
  • Supratentorial epidural hematoma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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