Surgical management of acute epidural hematomas

Neurosurgery. 2006 Mar;58(3 Suppl):S7-15; discussion Si-iv.


Indications for surgery: An epidural hematoma (EDH) greater than 30 cm3 should be surgically evacuated regardless of the patient's Glasgow Coma Scale (GCS) score. An EDH less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift (MLS) in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic (CT) scanning and close neurological observation in a neurosurgical center.

Timing: It is strongly recommended that patients with an acute EDH in coma (GCS score < 9) with anisocoria undergo surgical evacuation as soon as possible.

Methods: There are insufficient data to support one surgical treatment method. However, craniotomy provides a more complete evacuation of the hematoma.

Publication types

  • Review

MeSH terms

  • Disease Management
  • Humans
  • Intracranial Hemorrhage, Traumatic / pathology
  • Intracranial Hemorrhage, Traumatic / surgery*
  • Neurosurgical Procedures / methods*