• Neurosurgery · Mar 2006

    Review

    Surgical management of acute epidural hematomas.

    • M Ross Bullock, Randall Chesnut, Jamshid Ghajar, David Gordon, Roger Hartl, David W Newell, Franco Servadei, Beverly C Walters, Jack E Wilberger, and Surgical Management of Traumatic Brain Injury Author Group.
    • Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
    • Neurosurgery. 2006 Mar 1; 58 (3 Suppl): S7-15; discussion Si-iv.

    Indications For SurgeryAn 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.TimingIt is strongly recommended that patients with an acute EDH in coma (GCS score < 9) with anisocoria undergo surgical evacuation as soon as possible.MethodsThere are insufficient data to support one surgical treatment method. However, craniotomy provides a more complete evacuation of the hematoma.

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