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

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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

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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., Lin -, T. K., Epstein, M. H., & Horwitz, N. H. (1993). The expectant treatment of 'asymptomatic' supratentorial epidural hematomas. Neurosurgery, 32(2), 176-179.