The factors affecting the prognosis of surgically treated acute epidural hematoma patients: The retrospective analysis of 89 cases
Abstract
Aim: The most
common cause of acute epidural hematoma (AEH) is parietotemporal bone fractures
due to injury of the arteria meningea media. In this study, we aimed to
investigate the factors affecting prognosis in patients operated with the
diagnosis of acute epidural hematoma in our clinic. Methods: Between 2007 and
2018, eighty-nine patients who were diagnosed as AEH in the Department of
Neurosurgery, Faculty of Medicine, Mersin University were included in the
study. Patients were divided into groups according to the age, initial Glasgow
coma scale (GCS), neurological findings, location, extent and operation of AEH.
The findings were compared according to mortality, morbidity, intensive care
and discharge period. Results: Seventy-five of the patients were
male, 14 were female and the mean age was 25.7 years. The most common
localization of the hematoma was parietotemporal region in 31 (34.8%)patients.
The hematoma was evacuated by craniotomy in 59 (66.3%) patients while
craniectomy was done in 30 (33%) patients for treatment. The worst clinical
outcomes were found in patients with GCS 8 and below after arrival. The
complications (44;0%) and mortality rates (52,0%) were found to be high in those
patients and the mean hospitilization period was found as 18.3 days. Conclusion: Early diagnosis and
treatment, the presence of high GCS, age less than 18 years and hematoma
thickness less than 20 mm were found to be associated with good prognosis,
while temporal location of the hematoma was predicted to be associated with
poor prognosis.
References
- 1. Rivas JJ, Lobato RD, Sarabia R, et al. Extradural Hematoma: Analysis of Factors Influencing the Courses of Patients. Neurosurgery 1988;23:44-51. 2. Lee E, Hung Y, Wang L, et al. Factors influencing the functional outcome of patients with acute epidural hematomas: Analysis of 200 patients undergoing surgery. J Trauma 1998;45:946–952. 3. Meier U, Heinitz A, Kintzel D. Surgical outcome after severe craniocerebral trauma in childhood and adulthood. A comparative study [in German]. Unfallchirurg 1994; 97: 406–409. 4. Mohanty A, Kolluri V, Subbakrishna D, et al. Prognosis of extradural haematomas in children. Pediatr Neurosurg 1995;23:57–63. 5. Seelig J, Marshall L, Toutant S, et al. Traumatic acute epidural hematoma: Unrecognized high lethality in comatose patients. Neurosurgery 1984;15:617–620. 6. Kuday C, Uzan M, Hancı M. Statistical analysis of the factors affecting the outcome of extradural haematomas: 115 cases. Acta Neurochir (Wien) 1994;131:203–206. 7. Sullivan T, Jarvik J, Cohen W. Follow-up of conservatively managed epi- dural hematomas: Implications for timing of repeat CT. AJNR Am J Neuroradiol 1999;20:107–113.8. Pillay R, Peter J. Extradural haematomas in children. S Afr Med J 1995;85:672– 674. 9. Jones N, Molloy C, Kloeden C, et al. Extradural haematoma: Trends in outcome over 35 years. Br J Neurosurg 1993;7:465–471. 10. Wester K. Decompressive surgery for ‘’pure’’ epidural hematomas: Does neurosurgical expertise improve the outcome? Neurosurgery 1999;44:495–500. 11. Heinzelmann M, Platz A, Imhof H. Outcome after acute extradural haematoma, influence of additional injuries and neurological complications in the ICU. Injury 1996;27:345–349. 12. van den Brink WA, Zwienenberg M, Zandee SM, et al . The prognostic importance of the volume of traumatic epidural and subdural haematomas revisited. Acta Neurochir (Wien) 1999;141:509–514. 13. Lahat E, Sheinman G, Feldman Z, et al. Metabolic and clinical markers of prognosis in the era of CT imaging in children with acute epidural hematomas. Pediatr Neurosurg 2000;33:70–75. 14. Hamilton M, Wallace C: Nonoperative management of acute epidural he- matoma diagnosed by CT: the neuroradiologist’s role. Am J Neuroradiol 1992; 13: 853–59. 15. Jamous MA, Abdel Aziz H, Al Kaisy F, et al. Conservative management of acute epidural hematoma in a pediatric age group. Pediatr Neurosurg 2009; 45: 181–84. 16. Knuckey NW, Gelbard S, Epstein MH: The management of “asymptomatic” epidural hematomas. A prospective study. J Neurosurgm, 1989; 70: 392–96. 17. Balmer B, Boltshauser E, Altermatt S, et al. Conservative management of significant epidural haematomas in children. Child’s nervous system: ChNS. Off J International Soc Pediatr Neurosurg. 2006; 22: 363–67. 18. Bullock R, Smith RM, van Dellen JR. Nonoperative management of extra- dural hematoma. Neurosurgery 1985; 16(5): 602–6. 19. Pozzati E, Tognetti F. Spontaneous healing of acute extradural hematomas: study of twenty-two cases. Neurosurgery, 1986; 18(6): 696–700. 20. Kolodziej W, Kiza P, Podgorski D. Acute posttraumatic epidural hematoma. Neurol Neurochir Pol 1999; 33(4): 955-70. 21. Skadorwa T, Zygańska E, Eibl M, et al. Distinct strategies in the treatment of epidural hematoma in children: clinical considerations. Pediatr Neurosurg 2013; 49(3): 166–71.22. Keeney SE, Adcock EW, McArdle CB. Prospective observations of 100 high-risk neonates by highfield (1.5 Tesla) magnetic resonance imaging of the central nervous system. Intrventricular and extracerabral lesions. Pediatrics 1991; 87(4) : 421-30. 23. Chen TY, Wong CW, Chang CN et al. The expectant treatment of “asymptomatic” supratentorial epidural hematomas. Neurosurgery 1993; 32(2): 176–79. 24. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute epidural hematomas. Neurosurgery 2006; 58(3 Suppl.): S7–15; discussion Si-iv. 25. Servadei F, Faccani G, Roccella P, et al. Asymptomatic extradural haematomas. Results of a multicenter study of 158 cases in minor head injury. Acta Neurochir (Wien) 1989;96:39–45. 26. Bezircioglu H, Ersahin Y, Demircivi F, et al. Nonoperative treatment of acute extradural hematomas: Analysis of 80 cases. J Trauma 19996;41:696–698.27. Bejjani G, Donahue D, Rusin J, et al. Radiological and clinical criteria for the management of epidural hematomas in children. Pediatr Neurosurg 1996;25:302–308.28. Cohen J, Montero A, Israel Z: Prognosis and clinical relevance of anisocoria- craniotomy latency for epidural hematoma in comatose patients. J Trauma 1996;41:120–122. 29. Paterniti S, Fiore P, Macri E, et al. Extradural haematoma. Report of 37 consecutive cases with survival. Acta Neurochir (Wien) 1994;131:207–210. 30. Lobato R, Rivas J, Cordobes F, et al. Acute epidural hematoma: An analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg 1988;68:48–57.
Cerrahi olarak tedavi edilen akut epidural hematomlu hastalarda prognoz üzerine etki eden faktörler: Seksendokuz hastanın retrospektif analizi
Abstract
Amaç: Akut epidural hematom
(AEH) kafa travması sonrası sıklıkla
temporoparietal kemik kırıkları nedeni ile arteria meningea medianın
yaralanması sonucu görülmektedir. Bu çalışmada, kliğimizde akut epidural
hematom tanısı konularak opere edilen hastalarda, prognozu etkileyen
faktörlerin araştırılması amaçlanmıştır. Yöntem: Çalışmaya, 2007-2018
yılları arasında Mersin Üniversitesi Tıp Fakültesi Beyin ve Sinir Cerrahisi
Anabilim Dalı’nda AEH tanısı alarak cerrahi yöntemle tedavi edilen 89 hasta
dahil edilmiştir. Hastalar yaş
grupları, geliş Glasgow koma skalası (GKS), nörolojik bulguları, AEH’nin yeri,
genişliği ve yapılan operasyon şekline göre gruplara ayrılmıştır. Hastalarda
mortalite, morbidite, yoğun bakım ve hastane kalış sürelerine göre prognoz
kriterleri belirlenmeye çalışılmıştır. Bulgular:
Hastaların 75’i erkek, 14’ü kadın olup, ortalama yaş 25.7 olarak tespit
edildi. Hastalarda görülen en sık başvuru bulgusu şuur değişikliği idi (%66.9).
Hematomun en sık görüldüğü lokalizasyon 31 (%34.8) hastada parietotemporal
bölge olarak saptandı. Ellidokuz (%66.3) hastada kraniyotomi ile hematom
boşaltılırken, 30 (%33.0) hastada
kraniektomi ile hematom boşaltıldı. En kötü klinik sonuçlar geliş GKS’si 8 ve
altında olan hastalarda tespit edilmiştir. Bu hastalarda komplikasyon (%44.0),
mortalite (%52.0) oranı oldukça yüksek ve hastanede yatış sürelerinin (ortalama
18.3 gün) uzun olduğu saptanmıştır. Hematom kalınlığı 20 mm üzerinde olan
hastalarda komplikasyon ve mortalite oranı yüksek bulunmuştur. Sonuç: AEH’de erken tanı ve tedavinin
yanısıra geliş GKS’sinin yüksek olması, hastanın yaşının 18’den daha küçük
olması ve hematom kalınlığının 20 mm’den küçük olması iyi prognozla ilişkili
olarak tespit edilmişken, hematomun temporal bölgede yer almasının kötü
prognozla ilişkili olabileceği öngörülmüştür.
References
- 1. Rivas JJ, Lobato RD, Sarabia R, et al. Extradural Hematoma: Analysis of Factors Influencing the Courses of Patients. Neurosurgery 1988;23:44-51. 2. Lee E, Hung Y, Wang L, et al. Factors influencing the functional outcome of patients with acute epidural hematomas: Analysis of 200 patients undergoing surgery. J Trauma 1998;45:946–952. 3. Meier U, Heinitz A, Kintzel D. Surgical outcome after severe craniocerebral trauma in childhood and adulthood. A comparative study [in German]. Unfallchirurg 1994; 97: 406–409. 4. Mohanty A, Kolluri V, Subbakrishna D, et al. Prognosis of extradural haematomas in children. Pediatr Neurosurg 1995;23:57–63. 5. Seelig J, Marshall L, Toutant S, et al. Traumatic acute epidural hematoma: Unrecognized high lethality in comatose patients. Neurosurgery 1984;15:617–620. 6. Kuday C, Uzan M, Hancı M. Statistical analysis of the factors affecting the outcome of extradural haematomas: 115 cases. Acta Neurochir (Wien) 1994;131:203–206. 7. Sullivan T, Jarvik J, Cohen W. Follow-up of conservatively managed epi- dural hematomas: Implications for timing of repeat CT. AJNR Am J Neuroradiol 1999;20:107–113.8. Pillay R, Peter J. Extradural haematomas in children. S Afr Med J 1995;85:672– 674. 9. Jones N, Molloy C, Kloeden C, et al. Extradural haematoma: Trends in outcome over 35 years. Br J Neurosurg 1993;7:465–471. 10. Wester K. Decompressive surgery for ‘’pure’’ epidural hematomas: Does neurosurgical expertise improve the outcome? Neurosurgery 1999;44:495–500. 11. Heinzelmann M, Platz A, Imhof H. Outcome after acute extradural haematoma, influence of additional injuries and neurological complications in the ICU. Injury 1996;27:345–349. 12. van den Brink WA, Zwienenberg M, Zandee SM, et al . The prognostic importance of the volume of traumatic epidural and subdural haematomas revisited. Acta Neurochir (Wien) 1999;141:509–514. 13. Lahat E, Sheinman G, Feldman Z, et al. Metabolic and clinical markers of prognosis in the era of CT imaging in children with acute epidural hematomas. Pediatr Neurosurg 2000;33:70–75. 14. Hamilton M, Wallace C: Nonoperative management of acute epidural he- matoma diagnosed by CT: the neuroradiologist’s role. Am J Neuroradiol 1992; 13: 853–59. 15. Jamous MA, Abdel Aziz H, Al Kaisy F, et al. Conservative management of acute epidural hematoma in a pediatric age group. Pediatr Neurosurg 2009; 45: 181–84. 16. Knuckey NW, Gelbard S, Epstein MH: The management of “asymptomatic” epidural hematomas. A prospective study. J Neurosurgm, 1989; 70: 392–96. 17. Balmer B, Boltshauser E, Altermatt S, et al. Conservative management of significant epidural haematomas in children. Child’s nervous system: ChNS. Off J International Soc Pediatr Neurosurg. 2006; 22: 363–67. 18. Bullock R, Smith RM, van Dellen JR. Nonoperative management of extra- dural hematoma. Neurosurgery 1985; 16(5): 602–6. 19. Pozzati E, Tognetti F. Spontaneous healing of acute extradural hematomas: study of twenty-two cases. Neurosurgery, 1986; 18(6): 696–700. 20. Kolodziej W, Kiza P, Podgorski D. Acute posttraumatic epidural hematoma. Neurol Neurochir Pol 1999; 33(4): 955-70. 21. Skadorwa T, Zygańska E, Eibl M, et al. Distinct strategies in the treatment of epidural hematoma in children: clinical considerations. Pediatr Neurosurg 2013; 49(3): 166–71.22. Keeney SE, Adcock EW, McArdle CB. Prospective observations of 100 high-risk neonates by highfield (1.5 Tesla) magnetic resonance imaging of the central nervous system. Intrventricular and extracerabral lesions. Pediatrics 1991; 87(4) : 421-30. 23. Chen TY, Wong CW, Chang CN et al. The expectant treatment of “asymptomatic” supratentorial epidural hematomas. Neurosurgery 1993; 32(2): 176–79. 24. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute epidural hematomas. Neurosurgery 2006; 58(3 Suppl.): S7–15; discussion Si-iv. 25. Servadei F, Faccani G, Roccella P, et al. Asymptomatic extradural haematomas. Results of a multicenter study of 158 cases in minor head injury. Acta Neurochir (Wien) 1989;96:39–45. 26. Bezircioglu H, Ersahin Y, Demircivi F, et al. Nonoperative treatment of acute extradural hematomas: Analysis of 80 cases. J Trauma 19996;41:696–698.27. Bejjani G, Donahue D, Rusin J, et al. Radiological and clinical criteria for the management of epidural hematomas in children. Pediatr Neurosurg 1996;25:302–308.28. Cohen J, Montero A, Israel Z: Prognosis and clinical relevance of anisocoria- craniotomy latency for epidural hematoma in comatose patients. J Trauma 1996;41:120–122. 29. Paterniti S, Fiore P, Macri E, et al. Extradural haematoma. Report of 37 consecutive cases with survival. Acta Neurochir (Wien) 1994;131:207–210. 30. Lobato R, Rivas J, Cordobes F, et al. Acute epidural hematoma: An analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg 1988;68:48–57.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | December 31, 2019 |
| Submission Date | July 19, 2019 |
| Acceptance Date | September 18, 2019 |
| Published in Issue | Year 2019 Volume: 12 Issue: 3 |
Cite
MEU Journal of Health Sciences Assoc was began to the publishing process in 2008 under the supervision of Assoc. Prof. Gönül Aslan, Editor-in-Chief, and affiliated to Mersin University Institute of Health Sciences. In March 2015, Prof. Dr. Caferi Tayyar Şaşmaz undertook the Editor-in Chief position and since then he has been in charge.
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