Nonoperative Management of Acute Epidural Hematoma

Kim, K H; Shin, M S; Cho, K H; Kim, H K; Cho, K G

Abstract

Over a 5-year period the authors had treated conservatively 40 cases of the acute epidural hematomas, in which 33 lesions were in the supratentorial area and others in the infratentorial area. The configuration of the hematomas was mostly focal and most of them did not show mass effect in aspect of midline shift. But there were 2 cases with over 10mm of midline shifting which were located at the frontoparietal and temporoparietal area. The hematomas at the parietal area and posterior fossa did not make the midline shifting. 36 patients among 40 patients with the epidural hematomas were successfully treated in the nonoperative management. The clinical findings of these patients were over 13 points of Glasgow coma scale, no focal neurological deficits and normal vital signs. And CT scan of These patients revealed less 10mm of midline shifting, less 40cc amount of hematoma, hematomas located in all area except temporal and hematoma without associated intradural lesions. Four patients failed in conservative treatment underwent evacuation of the hematoma. Relative poor mentation on admission(G.C.S. > or = 13), large volume of hematoma, expansile, volume course and associated intradural lesions were considered as failure factors.