[Treatment options in traumatic epidural hematomas]

The authors report 118 consecutive cases of patients with traumatic extradural hematoma (EDH) which were analyzed according to different clinical parameters and treatment modalities. Patients, treated for EDH between 1992 and 1998 in our department were distributed into 5 treatment groups depending on their clinical and neuroradiological findings on admission and during the hospitalization. Group I consisted of 75 patients (64%) who required immediate surgical evacuation of the hematoma after admission. Group II included 12 patients (10%) with initially conservative treatment despite visible EDH on the first CT-scan, which had to be operated on in the course because of neurological deterioration or increase of hematoma size. The 14 patients (12%) forming group III developed an acute EDH after the initial CT-scan revealed no extradural blood; 7 patients (6%) out of group IV showed a chronic EDH (delay trauma/diagnosis > 72 h), which required operative evacuation. All 10 patients (8%) comprising group V were treated conservatively. In each group the following parameters were analyzed: patient age, size and location of hematoma, trauma mechanism, additional intracranial lesions or skull fractures, intraoperative findings and neurostatus on admittance and during the hospitalization. The decision for non-operative treatment of EDH and the timing of a delayed intervention has to be made individually in each case in dependence of parameters like patient age, hematoma-size and -location and neurological status and course. Chronic EDH should be operated immediately, as well as hematomas presenting with an increase in size. Delayed developing EDH imply worse outcome and make adequate surveillance of high-risk patients mandatory.