Quintanal CNE, Felipe MA, Cañizares MC, Pérez LP, Prince LJ

Language: Spanish
References: 29
Page: 156-161
PDF size: 296.64 Kb.

ABSTRACT

Objective: To analyze indication, evolution and results of conservative treatment in patients with epidural hematoma assisted in Hospital Militar Central “Dr. Luis Díaz Soto” (La Habana, Cuba).
Methods: Presentation of 23 patients with traumatic acute epidural hematoma who underwent conservative treatment. The main inclusion criteria were the following: Glasgow coma score equal to or greater than 12, absence of focal neurological signs, progressive improvement of the clinical status, and a hematoma diameter smaller than or equal to 1.5 cm on the computed tomography scan, with a midline shift equal to or smaller than 3 mm and presence of basal cisterns.
Results: Only one patient required surgical treatment due to a cerebral contusion and subdural hematoma underlying the epidural hematoma. All patients evolved satisfactorily. Total resolution of the hematoma was found to occur between 1 and 7 months, a period in which patients were either asymptomatic or had mild headaches and postural dizziness.
Conclusions: Conservative treatment is safe and effective for selected patients. Most epidural hematomas were reabsorbed during the first month of evolution. CT played a fundamental role in the diagnosis and follow–up of these patients. There were no complications related to the conservative treatment. Patients had a good evolution and fully resumed their work.

REFERENCES

1. Centers for Disease Control and Prevention. Web–based injury statistics query and reporting system (WISQARS). [citado: 2.12.2011]. Disponible en: www.cdc.gov/injury/wisqars

2. Mangat HS. Severe Traumatic Brain Injury. Continuum Lifelong Learning Neurol. 2012;18(3):532–46.

3. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2010.

4. Bullock MR, Hovda DA. Introduction to Traumatic Brain Injury. En: Winn HR, ed. Youmans: Neurological Surgery. 6 e. Philadelphia: Elsevier Saunders; 2011. p. 3267–9.

5. Jamieson KG, Yelland JD. Extradural hematoma: Report of 167 cases. J Neurosurg. 1968;29:13–23.

6. Heiskanen O. Epidural hematoma. Surg Neurol. 1975;4:23–6.

7. Guillermain P. Traumatic extradural hematomas. Adv Neurotraumatol. 1986;1:1–50.

8. Blumbergs PC. Neuropathology of Traumatic Brain Injury. En: Winn HR, ed. Youmans: Neurological Surgery. 6 ed. Philadelphia: Elsevier Saunders; 2011. P. 3288–99.

9. Hamilton M, Wallace C. Nonoperative management of acute epidural hematoma diagnosed by CT: The Neurorradiologist’s role. AJNR Am J Neuroradiol. 1992;13:853–9.

10. Cordobés F, Lobato RD, Rivas JJ, Muñoz MJ, Chillón D, Portillo JM, Lamas E. Observations on 82 patients with extradural hematoma. Comparison of results before and after the advent of computerized tomography. J. Neurosurg. 1981;54:179–86.

11. Yamamoto M, Jimbo M, Ide M, Kitarnura K, Sugiura M. Conservative treatment of traumatic intracerebral hematoma. No Shinkei Geka. 1984;12(10):1131–8.

12. Bullock R, Smith RM, Van Deller JR. Nonoperative management of extradural hematoma. Neurosurgery. 1985;16:602–6.

13. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: A practical scale. Lancet. 1974;2:81.

14. Jennett B, Bond M. Assessment of outcome after severe brain damage: A practical scale. Lancet. 1975;1:480–4.

15. Servadei F, Faccani G, Roccella P, Seracchioli A, Godano U, Ghadirpour R, et al. Asymptomatic extradural hematomas. Results of a multicenter study of 158 cases in minor head injury. Acta Neurochir (Wien). 1989;96:39–45.

16. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute epidural hematomas. Neurosurgery. 2006;58:S7–S15.

17. Robertson C, Rangel–Castilla L. Critical Care Management of Traumatic Brain Injury. In: Winn HR, ed. Youmans: Neurological Surgery. 6 e. Philadelphia: Elsevier Saunders; 2011. p. 3397–423.

18. Pozzati E, Tognetti F. Spontaneous healing of acute extradural hematomas: study of 22 cases. Neurosurgery. 1986;18:696–700.

19. Knuckey NW, Gelbard S, Epstein MH. The management of “asymptomatic” epidural hematomas: A prospective study. J Neurosurg. 1989;70:392–6.

20. Shahlaie K, Zwienenberg–Lee M, Muizelaar JP. Clinical Pathophysiology of Traumatic Brain Injury. En: Winn HR, ed. Youmans: Neurological Surgery. 6 e. Philadelphia: Elsevier Saunders; 2011. p. 3362–79.

21. Kaufman HH. Nonoperative management of extradural hematoma (letter). Neurosurgery. 1985;16:606.

22. Dubey A, Pillai SV, Kolluri SV. Does volume of extradural hematoma influence management strategy and outcome?. Neurol India. 2004;52:443–5.

23. Dolgun H, Türkoglu E, Kertmen H, Yilmaz ER, Ergun BR, Sekerci Z. Rapid resolution of acute epidural hematoma: case report and review of the literature. Ulus Travma Acil Cerrahi Derg. 2011;17(3):283–5.

24. Kang SH, Chung YG, Lee HK. Rapid Disappearance of Acute Posterior Fossa Epidural Hematoma. Case Report. Neurol Med Chir (Tokyo). 2005;45:462–3.

25. Jamous MA, Aziz HA, FA Kaisy, Eloqayli H, Azab M, Al–Jarrah M. Conservative Management of Acute Epidural Hematoma in a Pediatric Age Group. Pediatr Neurosurg. 2009;45:181–4.

26. Flannery AM. Cautions in the Conservative Management of Epidural Hematomas. Pediatr Neurosurg. 2009;45:185.

27. Suzuki S, Endo M, Kurata A, Ohmomo T, Oka H, Kitahara T, et al. Efficacy of Endovascular Surgery for the Treatment of Acute Epidural Hematomas. AJNR Am J Neuroradiol. 2004;25:1177–80.

28. Kumbhani SR, Purcell DD, Gean AD. Contrast extravasation within a traumatic epidural hematoma: have we been missing something? Vancouver, Canada: American Society of Neuroradiology 47th Annual Meeting & NER Foundation Symposium; 2009.

29. Le TH, Gean AD. Imaging of Traumatic Brain Injury. In: Winn HR, ed. Youmans: Neurological Surgery. 6 ed. Philadelphia: Elsevier Saunders; 2011. p. 3242–61.