The expectant treatment of 'asymptomatic' supratentorial epidural hematomas

T. Y. Chen, C. W. Wong, C. N. Chang, T. N. Lui, W. C. Cheng, M. D. Tsai, T. K. Lin -, M. H. Epstein, N. H. Horwitz

Research output: Contribution to journalArticle

65 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
Publication statusPublished - 1993
Externally publishedYes

Fingerprint

Hematoma
Therapeutics
Skull Fractures
Glasgow Coma Scale
Temporal Bone
Bone Density
Brain Injuries
Hospitalization
Guidelines
Mortality
Wounds and Injuries
Brain

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Chen, T. Y., Wong, C. W., Chang, C. N., Lui, T. N., Cheng, W. C., Tsai, M. D., ... Horwitz, N. H. (1993). The expectant treatment of 'asymptomatic' supratentorial epidural hematomas. Neurosurgery, 32(2), 176-179.

The expectant treatment of 'asymptomatic' supratentorial epidural hematomas. / Chen, T. Y.; Wong, C. W.; Chang, C. N.; Lui, T. N.; Cheng, W. C.; Tsai, M. D.; Lin -, T. K.; Epstein, M. H.; Horwitz, N. H.

In: Neurosurgery, Vol. 32, No. 2, 1993, p. 176-179.

Research output: Contribution to journalArticle

Chen, TY, Wong, CW, Chang, CN, Lui, TN, Cheng, WC, Tsai, MD, Lin -, TK, Epstein, MH & Horwitz, NH 1993, 'The expectant treatment of 'asymptomatic' supratentorial epidural hematomas', Neurosurgery, vol. 32, no. 2, pp. 176-179.
Chen TY, Wong CW, Chang CN, Lui TN, Cheng WC, Tsai MD et al. The expectant treatment of 'asymptomatic' supratentorial epidural hematomas. Neurosurgery. 1993;32(2):176-179.
Chen, T. Y. ; Wong, C. W. ; Chang, C. N. ; Lui, T. N. ; Cheng, W. C. ; Tsai, M. D. ; Lin -, T. K. ; Epstein, M. H. ; Horwitz, N. H. / The expectant treatment of 'asymptomatic' supratentorial epidural hematomas. In: Neurosurgery. 1993 ; Vol. 32, No. 2. pp. 176-179.
@article{3970110962c442de931a0a6a7ee269bc,
title = "The expectant treatment of 'asymptomatic' supratentorial epidural hematomas",
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.",
keywords = "Computed tomograms, Epidural hematoma, Expectant treatment, Head injury, Hospitalization, Supratentorial epidural hematoma",
author = "Chen, {T. Y.} and Wong, {C. W.} and Chang, {C. N.} and Lui, {T. N.} and Cheng, {W. C.} and Tsai, {M. D.} and {Lin -}, {T. K.} and Epstein, {M. H.} and Horwitz, {N. H.}",
year = "1993",
language = "English",
volume = "32",
pages = "176--179",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - The expectant treatment of 'asymptomatic' supratentorial epidural hematomas

AU - Chen, T. Y.

AU - Wong, C. W.

AU - Chang, C. N.

AU - Lui, T. N.

AU - Cheng, W. C.

AU - Tsai, M. D.

AU - Lin -, T. K.

AU - Epstein, M. H.

AU - Horwitz, N. H.

PY - 1993

Y1 - 1993

N2 - 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.

AB - 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.

KW - Computed tomograms

KW - Epidural hematoma

KW - Expectant treatment

KW - Head injury

KW - Hospitalization

KW - Supratentorial epidural hematoma

UR - http://www.scopus.com/inward/record.url?scp=0027533790&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027533790&partnerID=8YFLogxK

M3 - Article

C2 - 8437654

AN - SCOPUS:0027533790

VL - 32

SP - 176

EP - 179

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 2

ER -