Extradural haematoma in children: Surgical experiences and prospective analysis of 170 cases

Abstract

Aim: We present our experiences in the management of extradural haematoma in children which involved an aggressive diagnostic approach, prompt surgical evacuation results in an excellent outcome. Material and Methods: 170 EDH patients who underwent surgery in our department from January 2006 to July 2010 included in this prospective study. Each patient evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome. Results: Out of 170 cases 72%, (n=122) were boys and 28 %,(n=48) were girls. The boys to girls ratio was 2.54: 1. Age ranged from 1.8 to 18 years with a mean age of 9.49 years. Most of the victims are in the 11-18 years age group 44% (n=74). The most common mode of injury was fall 41%, (n = 70) followed by Road traffic Accident (RTA) 32%, (n = 54). The most common clinical presentation was altered sensorium 61 %, (n= 104), followed by headache and/or vomiting 56 %, (n = 96). The mortality rate was 8%. Conclusion: EDH is recognized as one of the most rewarding neurosurgical emergencies. It must be diagnosed in the early period of the trauma and evacuated early to prevent potential mortality and morbidity. Different factors affect the outcome of extradural haematoma Surgery including age of the patient, presence of cranial fractures, associated brain lesions and pre-operative neurological condition of patient, duration of time interval between onset of coma and surgical intervention. Better prognosis is seen in patients less than 10 years of age.