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Journal of Korean Neurosurgical Society 1988;17(5): 1003-1012.
Outcome of Nonoperative Management for Intracranial Acute Epidural Hematomas: Analysis of 43 Cases.
Eun Young Kim, Hwan Yung Chung, Nam Kyu Kim, Kwang Myung Kim, Suck Jun Oh
Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea.
The authors present 43 cases of intracranial acute epidural hematomas(EDH's) managed by close observation. In each of 43 cases, the following criteria were met:1) the patient was conscious soon after head injury;2) the volume of hematoma was under 30ml(10ml in case of posterior fossa EDH's);3) there was no severe effacement of basal cistern or 4th ventricle;4) there was no associated intradural lesion;5) the patient showed neither cerebral herniation nor cardiorespiratory abnormalies. Of the 43 patients, 31(72%) showed no hematoma enlargement, and showed rsolution of hematoma on computerized tomography(CT) scans over a period of 4 to 11 weeks. Repeat CT scans within 24 hours of initial CT revealed enlargement of EDH in 12 of 43 patients(28%), of these 12 EDH's, 5 were reabsorbed spontaneously from 6 to 10 weeks, and 7 were evacuated surgically. All patients recovered without morbidity except one who had craniotomy during observation. There was no specific location of EDH which was indicated or contraindicated for conservative treatment. Factors that influence outcome include the age of patient, initial CT finding, cerebrospinal fluid(CSF) leakage, the use of mannitol, and recovery from shock. Hematoma enlargement did not always accompany deterioration of consciousness, therefore repeat CT scans within 24 hours is strongly recommended.
Key Words: Epidural hematoms; Hematoma enlargement; Spontaneous resolution; Computerized tomography
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