TITLE:
Surgical Outcome of Extradural Hematoma Patients in Relation to Preoperative Neurological Status
AUTHORS:
Reaz A. Howlader, Asit C. Sarker, Sukriti Das, Manirul Islam, Uzzal K. Sadhukhan, Lima Yasmin
KEYWORDS:
Epidural Hematoma, Surgical, Outcome, Traumatic, Postoperatively
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.11 No.4,
September
18,
2021
ABSTRACT: Introduction: Epidural hematoma (EDH) is characterized by the
acute onset of traumatic haemorrhage into potential space between the dura
mater and skull following head injury. About 85% of the epidural cases are
caused by skull fracture with rupture of the middle meningeal artery or its
branches and rest of 1the time ruptured venous sinuses, fractured diploic bone.
The BTF recommends that all patients with an EDH volume of greater than 30 cc
should undergo surgical evacuation regardless of Glasgow Coma Scale (GCS). Aim
of the Study: To assess the surgical outcome of extradural hematoma
patients by using Glasgow Outcome Scale (GOS) postoperatively. Material
& Methods: This prospective study was conducted in the Department of
Neurosurgery, Dhaka Medical College and Hospital (DMCH), during the period of
January 2016 to December 2017. A total of 98 patients of both sex and any age
with EDH were selected purposively. Statistical analyses were carried out by
using the Statistical Package for Social Sciences version 22.0 for Windows
(SPSS Inc., IBM and New York, USA). Prior to commencement of this study, the
“Research Review Committee” & the “Ethical Committee” of DMCH, Dhaka,
approved the research protocol. Results: In this study, 98 patients were
included; they were divided into 6 groups. Age range was 04 - 55
years. It was observed that majority, 30 (30.60%) patients were from 21 - 30
years of age. The mean age was found 25.24 ± 12.2 years. Other age related
distributions were shown in the table. Male patients were 78 (78.55%) and 22
(22.44%) patients were female. A male predominance was observed. Among
admitting GCS 3-8, 56.25% patients had unfavorable outcome and 43.25% had
favorable outcome. Admitting GCS 9-13, 2.5% patients had unfavorable outcome and
97.5% had favorable outcome. Admitting GCS 14-15, all patients (100.0%) had
favorable outcome. Unfavorable outcome was observed in 9 (9.18%),
1 (1.00%) patients who belong 3-8, 9-13 GCS on
admission. Mean GCS on admission was found 6.7 ± 2.44
score in unfavorable outcome group and 13.45 ± 2.30
score in favorable outcome group. Conclusion: This study revealed good
surgical outcome in extradural hematoma patients. Preoperative GCS is an
important predictor of outcome. Other preoperative neurological statuses like
pupillary changes, neurological focal deficit, cranial nerve involvement, plantar
reflexes and seizure also influence the surgical outcome.