Treatment of significant extradural hematomas in children without surgical intervention

Abstract

Objective:
"A  significant  extradural  hematoma  (EDH)  is  generally  treated  by craniotomy and removal of the hematoma."This is a report of treatment following  an  EDH  on  computerized  tomography  (CT)  in  children without surgical intervention. The authors examined whether this way of management is a successful and safe therapeutic option. 
Methods:  
Retrospective study was carried out by collecting data from charts of patients  with  EDH  treated  without  surgical  intervention  in  Tikrit teaching hospital between June 2016 and February 2020. "Included were patients without focal neurological deficits, with a Glasgow Coma Scale (GCS)  of  15  and  an  initial  CT  showing  an  EDH  with  a  minimal thickness  of  1  cm.  Mild  clinical  symptoms  of  increased  intracranial pressure  such  as  headache,  nausea  or  vomiting  were  managed symptomatically".  "Follow-up  included  a  standardized  interview,  a neurological examination and CT". 
Results:  
Thirteen children with EDH had success without surgical intervention. Only one 11-year-old male patient with a delayed diagnosed parietal EDH required surgical removal 24 h after admission and 4 days after the insult. Clinical follow-up showed patients without neurological deficits, a Glasgow Outcome Scale of 15 over one year. Follow-up CT showed complete resolution of the EDH within 2 to 3 months.  
Conclusions:  
Our  study  demonstrates  that  significant  EDH  can  be  managed conservatively in neurologically normal children. We recommend that such  treatment  be  carried  out  in  specialized  centers  under  adequate neurological observation since urgent surgery in case of neurological deterioration may be carried out.