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Turkish Neurosurgery 6: 63 - 67, 1996 Yurt: Extradural Hnemntomn

Extradural Haematoma: Analysis of 190 Cases

Ekstradural Hematomlar: 190 Olgunun Analizi

ISMAIL YURT, HAM DI BEZIRCIOGLU, YUSUF ERSAHIN, FSUN DEMIRIVi,

MEHMET KAHRAMAN, SEVKET TEKTAS

Department of Neurosurgery, izmir State Hospita\ (IY, HB, FD, MK, STi, and Division of Paediatric Neurosurgery,Ege University Facu\ty of Medicine (YE), izmir, Turkey

Abstract: Traumatic extradural haematomas (EDHs)comprise 1 to 3% of all head trauma admissions. Theavailability of computed tomography has increased thediagnosis of extradural haematomas. From January 1,1986to December 31,1994,4,553 patients with head injury wereadmitted to the Department of Neurosurgery, Izmir StateHospitaL. Of 4,553 patients, 190 patients with surgicallytreated EDH were included in this study. There were 161males (85%) and 29 females (15%). The ages of the patientsranged from 4 to 70 years (mean 28 years). Seventy percentof the patients were between 15 and 40 years of age. Theoverall mortality was 15.7% (30 patients). All deathsoccurred in comatose patients, except for one case (p 10 days

80%

D survival

60%40%

.death

20%

624 h,s 2472 h,s 310 days

i .death Dsurvival

0%

0-6 h,sO

40

20

10

50

30

70

80

60

90

GCS scores of 125 patients were greater than 8and 65 (35%) were comatose. In some series, 35-40%of the patients were in the comatose group and 60-65% in non-comatose group (1,3).The mortality rateshave been reported 18-44% and 1% in comatose andnon-comatose subjects, respectively (3,10,13,16).

There were 20 deaths in 53 patients (37.7%) inwhich an active bleeding and a dot were detected atsurgery. However, of 132 patients in which a dot wasevacuated, only 10 (7.5%) died. Active bleeding wassignificantly associated with the worst outcome

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Turkis/i Neiirosiirgery 6: 63 - 67, 1996

(p< 0.0001). The number of deaths also variedsignificantly with the origin of EDH. The mortalityrates were 38%, 13.3% and 2.6% in arterial and

venous bleedings and in bleedings of unidentifiedorigin, respectively (p< 0.0001). it is conceivable thatthe development of EDH in a short time may beresponsible for a greater death rate in patients withan active bleeding.

In general, 73 % of patients with EDH have agood outcome. The outcome figure of our patientswas consistent with those in the literature (3,9,11).The experimental work of Ford and McLaurin (6)supports the hypothesis that the enlargement of acuteEDHs occurs shortly af ter the trauma. However, theIate enlargement of EDH in patients managedconservatively, and the development of delayedEDHs on serial CT scans are contrary to thishypothesis (15,17). The primary factor on outcomeis GCS scores of the patients at the time of surgery.Therefore early surgery is crucial in the managementof EDHs that are a dynamic process.

Correspondence: Or.Hamdi Bezircioglu1420 Sok. No:ll0-335220 Alsancak, Izmir, TurkeyPhone: (232) 463 49 10

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Yurt: Extradiiral Haematoma

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