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Extradural hematomas in children. 104 cases
Insights
Extradural hematomas in children are severe, with many showing no initial consciousness disturbance. Surgical outcomes were unsatisfactory, highlighting the need for improved treatment strategies for pediatric head injuries.
Area of Science:
- Pediatric Neurosurgery
- Traumatic Brain Injury
Background:
- Extradural hematomas (EDHs) are a significant cause of morbidity and mortality in children.
- Understanding the clinical presentation and management of pediatric EDHs is crucial for improving outcomes.
Purpose of the Study:
- To analyze the clinical features, diagnostic methods, and treatment outcomes of 104 pediatric extradural hematomas.
- To evaluate the effectiveness of surgical interventions and identify factors influencing prognosis.
Main Methods:
- Retrospective review of 104 pediatric cases with extradural hematomas.
- Analysis of clinical data, including neurological status, injury mechanisms, diagnostic imaging (angiography), and surgical techniques.
- Assessment of patient outcomes, including mortality and neurological sequelae.
Main Results:
- 104 pediatric EDHs were studied; 17 occurred in newborns, 2 in the posterior fossa.
- 57% had no initial loss of consciousness; 68% experienced a lucid interval (<24h in 60%).
- 19% lacked skull fractures; angiography aided diagnosis and surgical planning. Surgical results were unsatisfactory, with 18 deaths and 21 cases of motor sequelae.
Conclusions:
- Pediatric extradural hematomas present unique clinical features, including frequent absence of initial consciousness disturbance and lucid intervals.
- Cranial sutures, except the coronal suture, do not effectively limit hematoma spread.
- Current surgical approaches yield unsatisfactory results, necessitating further research into optimal management strategies for pediatric EDH.
Abstract:
The authors have studied the clinical features of 104 extradural hematomas in children. The frequency of this complication seems rather high and its severity undeniable. 17 cases were observed in newborns and 2 cases were localized in the posterior fossa. From a clinical point of view, 57% of the children had no disturbances in consciousness at the time of the injury, and 7% had no disturbances at anytime. A lucid interval was found in 68% of the cases, and this was less than 24 h in 60% of the cases. In 19% of the cases there was no skull fracture. Angiography allowed correct diagnosis and a better choice of the surgical technique. The hematoma was distinctly localized in 59 children, whereas it was widespread in 45, meaning that, excepting the coronal suture, the cranial sutures do not limit the spreading of an extradural hematoma. For treatment the authors prefer a bone flap with four or five holes (90 operations). The results are rather unsatisfactory. 18 patients died and in 21 (7.2%) the motor sequelae were the most important complications.