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Updated: May 1, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Conservative management of significant supratentorial epidural hematomas in pediatric patients
Muhammad Babar Khan1, Muhammad Riaz, Gohar Javed
1Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan, babarkhan08@gmail.com.
Insights
Conservative management of pediatric epidural hematomas (EDH) is effective and safe. Serial neurological examinations ensure successful outcomes, with surgery only needed in rare cases.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Trauma Management
Background:
- Epidural hematomas (EDH) typically require surgical evacuation.
- Pediatric patients with EDH may present with normal neurological exams.
- Conservative management is an alternative for select pediatric cases.
Purpose of the Study:
- To report presenting features, management, and outcomes of pediatric patients with EDH managed conservatively.
- To evaluate the safety and efficacy of serial neurological examinations in managing pediatric EDH.
Main Methods:
- Retrospective review of pediatric patients with EDH (≥1 cm thickness) managed conservatively.
- Follow-up included serial neurological examinations at 1, 3, 6, and 12 months.
- Parental quality of life assessment using a standardized questionnaire.
Main Results:
- 17 pediatric patients met inclusion criteria; 15 had successful conservative management.
- Two patients required craniotomy for hematoma evacuation.
- All patients achieved a Glasgow Outcome Scale (GOS) score of 5 at 1-year follow-up with normal schooling and satisfaction.
Conclusions:
- Conservative treatment is an optimal option for pediatric EDH with normal neurological exams.
- Serial neurological examinations provide safe and effective patient monitoring.
- Centers must have resources for emergent surgery and trained staff for conservative management protocols.
Background:
Radiologically significant epidural hematomas are generally treated with craniotomy and evacuation. However, pediatric patients with such hematomas may have normal neurological examinations. We aim to report the presenting features, management, and outcomes of pediatric patients who underwent conservative management of such hematomas at our center and also show that serial neurological examinations are a safe and effective way of managing these patients.
Methods:
A retrospective review of pediatric patients with extradural hematoma (EDH) thickness of at least 1 cm and who were conservatively managed was performed. All patients were followed up in neurosurgery outpatient clinics after discharge at 1-month, 3-month, 6-month, and 1-year intervals. Detailed neurological examination was performed at each visit, and a standardized questionnaire was also used to document the parent's subjective opinion of the patient's quality of life.
Results:
A total of 17 patients satisfied the study criteria and were included. Conservative management was successful in 15 patients, while a craniotomy with evacuation of hematoma had to be performed in two patients. All patients had a GOS score of 5 on 1-year follow-up, had normal schooling, and reported complete satisfaction with the management protocol.
Conclusion:
Conservative treatment is an optimal treatment option, and patients can be followed safely using a protocol of serial neurological examinations. A center must have resources to perform a craniotomy with evacuation of EDH in case of neurological worsening and be able to provide trained staff to carry out serial neurological examinations before treating these patients conservatively.
