They concluded that extradural haematoma can be managed non-operatively provided the Glasgow Coma Scale remains the same with symptomatic improvement. They also reviewed, at that time, the available literature from the past three decades as well as the guidelines for management of extradural haematoma. in 2013 described three cases of extradural haematoma and their management, focusing on operative and non-operative treatment. Over the last few years, there has been literature published about operative versus conservative management of extradural haematomas. McLaurin and Towbin mentioned in 1989 that the definitive treatment of extradural haematomas should always be surgical removal and delay of this treatment is unacceptable once the diagnosis has been established. The haematoma was in the temporal region in 24 patients (48%), in the posterior fossa in four (8%) patients and in the remainder the haematoma was either parietal or frontal.Įvery patient had a follow-up CT scan twice in the first 2 weeks and once every 2 weeks subsequent to that. None of our patients had a bleeding tendency. Thirty-six (72%) patients had a fissure fracture of the skull. None of them had papilloedema or a neurological deficit, but some of them had mild clinical symptoms such as headache, nausea or vomiting. They all remained fully conscious with a Glasgow Coma Scale of 15/15. The patients were regularly assessed clinically as an inpatient for 2 weeks and then they were followed up in the outpatient department for up to 14 weeks. There were no children among our patients. Out of the 50 patients, 42 (84%) are male and eight (16%) are female. There was a midline shift of less than 5 mm in four patients. The thickness of each of the extradural haematoma on the CT scan was less than 5 mm with a volume of less than 30 ml. This is a retrograde study of 50 patients who suffered a head injury and developed an extradural haematoma on CT scanning in the last 3 years and did not need surgery.Īnother 275 patients who had an extradural haematoma, during the same period and were treated surgically, were excluded from this study. When conservative treatment is considered, adequate neurological observation is mandatory. This depends on the neurological state of the patient rather than the size of the extradural haematoma. Radiologically significant extradural haematomas can be treated conservatively. They all made a complete recovery and showed resolution of the haematoma on CT scanning. Their condition was either static or improving.
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ResultsĪll the 50 patients were managed conservatively, being kept under neurosurgical care and were followed up by serial CT scanning. All the 50 patients had minimal symptoms and signs which were headache and rarely vomiting but no loss of consciousness, and none of the patients had papilloedema. A CT scan was done 24–48 h after the head injury. This study is limited only to the 50 patients who did not require surgery. During the same period, there were another 270 patients who had an extradural haematoma and all of them needed surgical treatment. This was during the last 3 years at Assiut University Hospital. The authors report 50 patients who had an extradural haematoma on computed tomographic scanning and did not need surgical treatment. If this can be shown as a suitable alternative to surgical intervention, it will offer a mode of treatment that has fewer potential complications and risks than the traditional surgical route. With the routine use of computed tomography (CT) for management of head injury patients, non-operative management is being used more often in selected patients (Narayan and Kempisy, Principles of Neurosurgery, 2005 Bricolo and Pasaut, Neurosurgery 14:8-12, 1984 Dubey et al., Neurol India 52:443-445, 2004 Offner et al., Am J Surg 192:801-805, 2006). These patients have traditionally been treated with urgent surgical evacuation of the haematoma to relieve the compression of the brain and brain stem (Bricolo and Pasaut, Neurosurgery 14:8-12, 1984). With the extensive blood supply to the vein, injury to the meningeal arteries leads to rapid intracranial bleeding of significant amounts of blood. Extradural haematomas form 0.5% of all head injuries (Narayan and Kempisy, Principles of Neurosurgery, 2005).
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