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The surgical outcome of traumatic extra-axial hematomas causing brain herniation in children

Bora Gürer1, Hayri Kertmen, Erdal R Yilmaz

  • 1Neurosurgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, Ministry of Health, Istanbul, Turkey.

Pediatric Neurosurgery
|July 31, 2014
PubMed

Insights

Emergency surgery for pediatric extra-axial hematomas causing brain herniation has a high mortality rate. Early intervention and intracranial pressure monitoring are crucial for improving outcomes in these critical pediatric neurosurgical cases.

Area of Science:

  • Pediatric Neurosurgery
  • Trauma Surgery
  • Neurological Emergencies

Background:

  • Traumatic extra-axial hematomas in children can lead to life-threatening brain herniation.
  • Emergency surgical intervention is often required but carries significant risks.

Purpose of the Study:

  • To evaluate surgical outcomes in children with extra-axial hematomas causing brain herniation.
  • To identify clinical and radiological prognostic factors for these pediatric patients.

Main Methods:

  • Retrospective analysis of 25 children undergoing emergency surgery for herniated traumatic extra-axial hematomas (2000-2010).
  • Assessment of surgical outcomes and correlation with clinical/radiological data.

Main Results:

  • Overall mortality was 44%. Subdural hematomas (SDH) had a higher mortality (52.9%) than epidural hematomas (EDH) (14.2%).
  • Factors predicting mortality included low Glasgow Coma Scale, high postoperative intracranial pressure (ICP), delayed surgery, prolonged herniation, brain swelling, large hematomas, and midline shift.

Conclusions:

  • Brain herniation from traumatic extra-axial hematomas is a severe pediatric neurosurgical condition.
  • Approximately one-third of affected children may achieve a favorable outcome.
  • Postoperative ICP monitoring and early decompressive surgery are recommended to improve results.
Abstract

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