Nonoperative treatment of acute extradural hematomas: analysis of 80 cases

Between 1986 and 1994, 270 patients with an acute extradural hematoma (EDH) were treated in the Department of Neurosurgery, Izmir State Hospital in Izmir, Turkey. Eighty patients with a supratentorial EDH of less than 30 mL in volume were treated conservatively. The 69 male and 11 female patients ranged in age from 5 to 68 years. Five of the patients subsequently underwent surgery because of the deterioration in the level of consciousness and enlargement of EDH. One patient died after the operation. EDHs were localized in the temporal region in all five patients who subsequently required the surgical intervention. It has been emphasized that the findings on a computed tomographic (CT) scan performed very early may be misleading in patients with an EDH in progress. We concluded that the temporal location of EDHs with heterogeneous density in patients whose CT scan was performed less than 6 hours after trauma had a higher risk of hematoma growth and thus should be treated surgically. Periodic CT scans should be performed at brief intervals during the early phase of hospitalization.