The expectant treatment of "asymptomatic" supratentorial epidural hematomas

Neurosurgery. 1993 Feb;32(2):176-9; discussion 179. doi: 10.1227/00006123-199302000-00004.

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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Female
  • Follow-Up Studies
  • Glasgow Coma Scale
  • Hematoma, Epidural, Cranial / diagnosis
  • Hematoma, Epidural, Cranial / surgery*
  • Hospitalization
  • Humans
  • Male
  • Skull Fractures / diagnosis
  • Skull Fractures / surgery
  • Tomography, X-Ray Computed