Decompressive Surgery for “Pure” Epidural Hematomas: Does Neurosurgical Expertise Improve the Outcome?

Decompressive Surgery for “Pure” Epidural Hematomas: Does Neurosurgical Expertise Improve the... AbstractOBJECTIVE:The goal of this study was to determine whether patients with “pure” epidural hematomas can now be transferred safely to a neurosurgical unit for decompression or whether general or orthopedic surgeons must still be prepared to perform emergency craniotomies.METHODS:Between 1984 and 1996, 83 patients were surgically treated in our department for pure epidural hematomas, i.e., without associated intracranial lesions. The patient records were analyzed with respect to hematoma thickness, signs of herniation, delays from accident to decompression, results of any surgical attempts in local hospitals before admittance to our department, and clinical outcomes.RESULTS:The mortality rate was low (1 patient death, 1.2%). Seventy-nine patients (95%) experienced good or moderate outcomes (Glasgow Outcome Scale scores of 4 or 5). Twenty-four children all experienced good outcomes (Glasgow Outcome Scale scores of 5). The median delay from accident to decompression was 6.5 hours (mean, 7.1 h). When emergency surgery was attempted by general or orthopedic surgeons in local hospitals, the effective decompression was delayed (median, 4 h; mean, 12.5 h), and the final outcomes were considerably worse than for patients who were transferred without such surgical attempts.CONCLUSION:Patients with pure epidural hematomas have better prognoses than previously assumed. There is usually enough time to safely transfer patients to a neurosurgical unit, provided that transport is rapid and anesthesiological services are available during the transport. Surgeons without training in neurosurgery should not perform emergency craniotomies in local hospitals but, rather, should transfer patients as quickly as possible to the nearest department of neurosurgery. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Decompressive Surgery for “Pure” Epidural Hematomas: Does Neurosurgical Expertise Improve the Outcome?

Neurosurgery , Volume 44 (3) – Mar 1, 1999

Decompressive Surgery for “Pure” Epidural Hematomas: Does Neurosurgical Expertise Improve the Outcome?

CLINICAL STUDIES Decompressive Surgery for "Pure" Epidural Hematomas: Does Neurosurgical Expertise Improve the Outcome? Knut Wester, M .D., Ph.D. Department of Neurosurgery, Haukeland University Hospital, University of Bergen, School of M edicine, Bergen, Norway OBJECTIVE: The goal of this study was to determine whether patients with "pure" epidural hematomas can now be transferred safely to a neurosurgical unit for decompression or whether general or orthopedic surgeons must still be prepared to perform em ergency craniotomies. METHODS: Between 1984 and 1996, 83 patients were surgically treated in our department for pure epidural hematomas, i.e., without associated intracranial lesions. The patient records were analyzed with respect to hematoma thickness, signs of herniation, delays from accident to decompression, results of any surgical attempts in local hospitals before admittance to our department, and clinical outcomes. RESULTS: The mortality rate was low (1 patient death, 1 .2 %). Seventy-nine patients (95%) experienced good or moderate outcomes (Glasgow O u tco m e Scale scores of 4 or 5). Twenty-four children all experienced good outcomes (Glasgow O u tco m e Scale scores of 5). The median delay from accident to decompression was 6.5 hours (mean, 7.1 h). When emergency surgery was attempted by general or orthopedic surgeons in local hospitals, the effective decompression was delayed (median, 4 h; mean, 12.5 h), and the final outcomes were considerably worse than for patients w ho were transferred without such surgical attempts. CONCLUSION: Patients with pure epidural hematomas have better prognoses than previously assumed. There is usually enough time to safely transfer patients to a neurosurgical unit, provided that transport is rapid and anesthesiological services are available during the transport. Surgeons without training in neurosurgery should not perform emergency craniotomies in local hospitals but, rather, should transfer...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199903000-00034
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:The goal of this study was to determine whether patients with “pure” epidural hematomas can now be transferred safely to a neurosurgical unit for decompression or whether general or orthopedic surgeons must still be prepared to perform emergency craniotomies.METHODS:Between 1984 and 1996, 83 patients were surgically treated in our department for pure epidural hematomas, i.e., without associated intracranial lesions. The patient records were analyzed with respect to hematoma thickness, signs of herniation, delays from accident to decompression, results of any surgical attempts in local hospitals before admittance to our department, and clinical outcomes.RESULTS:The mortality rate was low (1 patient death, 1.2%). Seventy-nine patients (95%) experienced good or moderate outcomes (Glasgow Outcome Scale scores of 4 or 5). Twenty-four children all experienced good outcomes (Glasgow Outcome Scale scores of 5). The median delay from accident to decompression was 6.5 hours (mean, 7.1 h). When emergency surgery was attempted by general or orthopedic surgeons in local hospitals, the effective decompression was delayed (median, 4 h; mean, 12.5 h), and the final outcomes were considerably worse than for patients who were transferred without such surgical attempts.CONCLUSION:Patients with pure epidural hematomas have better prognoses than previously assumed. There is usually enough time to safely transfer patients to a neurosurgical unit, provided that transport is rapid and anesthesiological services are available during the transport. Surgeons without training in neurosurgery should not perform emergency craniotomies in local hospitals but, rather, should transfer patients as quickly as possible to the nearest department of neurosurgery.

Journal

NeurosurgeryOxford University Press

Published: Mar 1, 1999

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