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Updated: Aug 8, 2026

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Surgical management of acute epidural hematomas
M Ross Bullock1, Randall Chesnut, Jamshid Ghajar
1Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Indications For Surgery:
An epidural hematoma (EDH) greater than 30 cm3 should be surgically evacuated regardless of the patient's Glasgow Coma Scale (GCS) score. An EDH less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift (MLS) in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic (CT) scanning and close neurological observation in a neurosurgical center.
Timing:
It is strongly recommended that patients with an acute EDH in coma (GCS score < 9) with anisocoria undergo surgical evacuation as soon as possible.
Methods:
There are insufficient data to support one surgical treatment method. However, craniotomy provides a more complete evacuation of the hematoma.
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