Cent Eur Neurosurg 2011; 72(04): 169-175
DOI: 10.1055/s-0031-1286261
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Post-Traumatic Frontal and Parieto-Occipital Extradural Haematomas: a Retrospective Analysis of 41 Patients and Review of the Literature

V. Balik
1   University Hospital Olomouc, Department of Neurosurgery, Olomouc, Czech Republic
,
H. Lehto
2   Helsinki University Hospital, Department of Neurosurgery, Helsinki, Finland
,
D. Hoza
3   Charles’s University and University Hospital in Motol, Department of Neurosurgery, Prague, Czech Republic
,
S. Phornsuwannapha
4   Police General Hospital, Division of Neurosurgery, Department of Surgery, Bangkok, Thailand
,
S. Toninelli
2   Helsinki University Hospital, Department of Neurosurgery, Helsinki, Finland
,
R. Romani
2   Helsinki University Hospital, Department of Neurosurgery, Helsinki, Finland
,
I. Sulla
5   Pavol Jozef Safarik University in Kosice, AD Centre, Department of Neurosurgery, Kosice, Slovak Republic
,
J. Hernesniemi
2   Helsinki University Hospital, Department of Neurosurgery, Helsinki, Finland
› Author Affiliations
Further Information

Publication History

Publication Date:
19 October 2011 (online)

Abstract

Background:

The purpose of this study was to analyse the differences between patients with frontal (FEDH) or parieto-occipital (POEDH) epidural haematomas and evaluate possible statistically significant prognostic factors.

Material and methods:

In this retrospective study of a group of 41 patients with a FEDH (17) or POEDH (24 individuals), the authors analysed the influence of gender, age, type of injury, clinical presentation, Glasgow coma scale (GCS) score on admission, radiological findings, and time interval from trauma to surgery on outcomes. A good recovery and moderate disability were considered a “good” or “favourable outcome”, whereas severe disability, a vegetative state or death was a “poor outcome”.

Results:

In the POEDH subgroup, a higher GCS score on admission and a younger age were statistically significant prognostic factors for a better outcome (p=0.006, rs=0.702). In the subgroup of patients with FEDHs, the results were not significant. However, patients with FEDHs more frequently had “good outcomes” than members of the POEDH subgroup (88.2 vs. 70.9%). Children (≤ 18 years old) constituted a smaller portion of the POEDH subgroup (12.5%) than those in the FEDH subgroup (41.2%). The evaluation of time intervals between the accident and surgery (≤ 24 h vs. > 24 h) showed no significant influence on outcomes in any of the studied subgroups. However, patients undergoing surgery within 24 h of their injury had a less favourable GCS score on admission than those operated on more than 24 h after their injury. Subacute and chronic clinical courses predominated in patients with a FEDH (10/17 FEDH vs. 11/22 POEDH). Different accompanying intradural lesions occurred in 12 patients of the POEDH subgroup, but only in 2 of the FEDH subgroup (50 vs. 11.8%). However, the presence of such lesions did not significantly deteriorate surgical outcomes in either of the subgroups.

 
  • References

  • 1 Askenasy HM, Kosary IZ, Braham J et al. An insidiously developing form of fronto-polar extradural haematoma. Neurochirurgia 1962; 4: 206-211
  • 2 Bahloul K, Xhumari A. Epidural hematoma revealed by exophthalmia, two cases reports. Clin Neurol Neurosurg 2009; 111: 893-895
  • 3 Balik V, Šulla I. Vertex extradural haematoma with associated lesions-improving clinical course with sudden death. Conservative versus surgical treatment. Bratisl Lek Listy 2007; 108: 409-413
  • 4 Balik V, Lehto H, Hoza D et al. Posterior fossa extradural haematomas. Cen Eur Neurosurg 2010; 71: 167-172
  • 5 Balmer B, Boltshauser E, Altermatt S et al. Conservative management of significant epidural haematomas in children. Childs Nerv Syst 2006; 22: 363-367
  • 6 Bejjani GK, Donahue DJ, Rusin J et al. Radiological and clinical criteria for the management of epidural hematomas in children. Pediatr Neurosurg 1997; 25: 302-308
  • 7 Bollinger B, Knudsen LL. Frontal epidural haematoma with ipsilateral exophthalmos. Neuroradiology 1987; 29: 315
  • 8 Borzone M, Rivano C, Altomonte M et al. Acute traumatic vertex epidural haematomas surgically treated. Acta Neurochir (Wien) 1988; 93: 55-60
  • 9 Bricolo A, Pasut L. Extradural hematoma: toward zero mortality. A prospective study. Neurosurgery 1984; 14: 8-12
  • 10 Bullock MR, Chesnut R, Ghajar J et al. Surgical management of acute epidural hematomas. Neurosurgery 2006; 58: S7-S15
  • 11 Bullock R, Van Dellen JR. Chronic extradural hematoma. Surg Neurol 1982; 18: 300-302
  • 12 Clare FB, Bell HS. Extradural hematomas. J Am Med Assoc 1961; 177: 887-891
  • 13 Clavel M, Onzain I, Gutierrez F. Chronic epidural hematomas. Acta Neurochir 1982; 66: 71-81
  • 14 Cohen J, Montero A, Israel Z. Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients. J Trauma 1996; 41: 120-122
  • 15 Cook RJ, Dorsch NWC, Fearnside MR et al. Outcome prediction in extradural haematomas. Acta Neurochir (Wien) 1988; 95: 90-94
  • 16 Cordobés F, Lobato RD, Rivas JJ et al. Observations on 82 patients with extradural hematoma. Comparison of results before and after the advent of computerized tomography. J Neurosurg 1981; 54: 179-186
  • 17 Corraddu M, Matricali B, Zwanikken CP. Chronic epidural haematoma. A non-typical course of extradural haemorrhage. Clin Neurol Neurosurg 1984; 86: 115-118
  • 18 Cucciniello B, Martellotta N, Nigro D et al. Conservative management of extradural haematomas. Acta Neurochir (Wien) 1993; 120: 47-52
  • 19 da Costa LB, de Andrade A, Henriques JGB et al. Traumatic bilateral intraorbital (subperiosteal) hematoma associated with epidural hematoma. Arq Neuropsiquiatr 2003; 61: 1039-1041
  • 20 de Vries J, Wattendorff AR, Hekster REM. Chronic epidural haematoma with partial rim enhancement. Neuroradiology 1981; 22: 167-168
  • 21 Fager CA. Subacute subdural hematoma. Surg Clin North Am 1958; 38: 877-883
  • 22 Fankhauser H, Kiener M. Delayed development of extradural haematomas. Acta Neurochir (Wien) 1982; 60: 29-35
  • 23 Fiume D, Interligi M, Nardi P et al. L’ematoma epidurale cronico. Studio di 53 casi operati. Riv Neurol 1985; 55: 350-356
  • 24 Gallagher JP, Browder EJ. Extradural hematoma. Experience with 167 patients. J Neurosurg 1968; 29: 1-12
  • 25 Garza-Mercado R, Campa H. Extradural hematoma due to traumatic pseudoaneurysm of middle meningeal artery. Surg Neurol 1978; 9: 103-105
  • 26 Gdovinova Z, Szilasiova J. Computed tomography. In: Gdovinova Z, Szilasiova J. eds Textbook of General Neurology. 1st edn. Kosice: Aprilla Ltd.; 2009: 152-158
  • 27 Głowacki J, Kusmiderski J, Kwiatkowski S et al. Atypical localisation of traumatic extradural hematomas. Neurosurg Rev 1989; 12 (Suppl. 01) 190-195
  • 28 Gorgulu A, Cobanoglu S, Armagan S et al. Bilateral epidural hematoma. Neurosurg Rev 2000; 23: 30-33
  • 29 Grevsten S, Pellettieri L. Surgical decision in the treatment of extradural hematoma. Acta Chir Scand 1982; 148: 97-102
  • 30 Gruszkiewicz J. Ipsilateral exophthalmos in subfrontal epidural hematomas. Report of four cases. J Neurosurg 1972; 37: 613-615
  • 31 Gruszkiewicz J, Platt HA. Subfrontal epidural hematomas. Neurochirurgia 1973; 16: 54-59
  • 32 Gruszkiewicz J, Doron Y, Peyser E. Frontal extradural hematomas. Surg Neurol 1976; 5: 122-128
  • 33 Guthkelch AN. Extradural haemorrhage as a cause of cortical blindness. J Neurosurg 1949; 6: 180-182
  • 34 Hamdi B, Yusuf E, Fusun D et al. Nonoperative treatment of acute extradural hematomas: analysis of 80 cases. J Trauma 1996; 41: 696-698
  • 35 Hamlat A, Mazzon A, Adn M et al. Intracranial epidural haematomas in elderly patients: observations in 14 patients. Acta Neurochir (Wien) 2005; 147: 1055-1060
  • 36 Heinzelmann M, Platz A, Imhof HG. Outcome after acute extradural haematoma, influence of additional injuries and neurological complications in the ICU. Injury 1996; 27: 345-349
  • 37 Hirsh LF. Chronic epidural hematomas. Neurosurgery 1980; 6: 508-512
  • 38 Hooper R. Observations on extradural haemorrhage. Br J Surg 1959; 47: 71-87
  • 39 Hunt J, Hill D, Besser M et al. Outcome of patients with neurotrauma: the effect of a regionalized trauma system. Aust NZ J Surg 1995; 65: 83-86
  • 40 Iwakuma T, Brunngraber CV. Chronic extradural hematomas. A study of 21 cases. J Neurosurg 1973; 38: 488-493
  • 41 Iwakuma T, Brunngraber CV. Extradural ossification following an extradural hematoma. J Neurosurg 1974; 41: 104-106
  • 42 Jackson IJ, Speakman TJ. Chronic extradural hematoma. J Neurosurg 1950; 7: 444-447
  • 43 Jamieson KG, Yelland JDN. Extradural hematoma. Report of 167 cases. J Neurosurg 1968; 29: 13-23
  • 44 Jamjoom A. The influence of concomitant intradural pathology on the presentation and outcome of patients with acute traumatic extradural haematoma. Acta Neurochir (Wien) 1992; 115: 86-89
  • 45 Jamjoom AB. The difference in the outcome of surgery for traumatic extradural hematoma between patients who are admitted directly to the neurosurgical unit and those referred from another hospital. Neurosurg Rev 1997; 20: 227-230
  • 46 Jawahar G, Natarajan M. Chronic extradural haematoma. J Indian Med Assoc 1985; 83: 413-416
  • 47 Jennet B, Bond M. Assessment of outcome after severe brain damage: A practical scale. Lancet 1975; 1: 480-484
  • 48 Jones NR, Molloy CJ, Kloeden CN et al. Extradural haematoma: trends in outcome over 35 years. Br J Neurosurg 1993; 7: 465-471
  • 49 Kars Z, Benli K, Saglam S et al. Chronic extradural haematoma: a late complication of head injury. Neurochirurgia 1985; 28: 145-146
  • 50 Kett-White R, Martin JL. Bilateral frontal extradural haematomas caused by rupture of the superior sagittal sinus: case report. Br J Neurosurg 1999; 13: 77-78
  • 51 Kissel P, Boggan JE, Wagner FC. CT Evolution of an acute venous epidural hematoma. J Emerg Med 1989; 7: 365-368
  • 52 Kotil K, Acetin MA. Asymptomatic chronic ossified epidural hematoma in a child: a rare entity. Ulus Travma Acil Cerrahi Derg 2006; 12: 164-166
  • 53 Kuday C, Uzan M, Hanci M. Statistical analysis of the factors affecting the outcome of extradural haematomas: 115 cases. Acta Neurochir (Wien) 1994; 131: 203-206
  • 54 Kvarnes TL, Trumpy JH. Extradural haematoma. Report of 132 cases. Acta Neurochir (Wien) 1978; 41: 223-231
  • 55 Lee E, Hung Y, Wang L et al. Factors influencing the functional outcome of patients with acute epidural hematomas: analysis of 200 patients undergoing surgery. J Trauma 1998; 45: 946-952
  • 56 Lobato RD, Rivas JJ, Cordobes F et al. Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg 1988; 68: 48-57
  • 57 Maggi G, Aliberti F, Petrone G et al. Extradural hematomas in children. J Neurosurg Sci 1998; 42: 95-99
  • 58 Mazza C, Pasqualin A, Feriotti G et al. Traumatic extradural haematoma in children: experience with 62 cases. Acta Neurochir (Wien) 1982; 65: 67-80
  • 59 McKissock W, Taylor JC, Bloom WH et al. Extradural haematoma. Observations on 125 cases. Lancet 1960; 2: 167-172
  • 60 Mohanty A, Kolluri V, Subbakrishna D et al. Prognosis of extradural haematomas in children. Pediatr Neurosurg 1995; 23: 57-63
  • 61 Munoz-Sánchez MA, Murillo-Cabezas F, Cayuela-Domínguez A et al. Skull fracture, with or without clinical signs, in mTBI is an independent risk marker for neurosurgically relevant intracranial lesion: a cohort study. Brain Inj 2009; 23: 39-44
  • 62 Naga A, Chellaoui A, Ibaihoiu K et al. Subperiosteal hematoma of the orbit associated with subfrontal extradural hematoma. Neurochirurgie 2002; 48: 101-103
  • 63 Nagane M, Oyama H, Shibui S et al. Ossified and calcified epidural hematoma incidentally found 40 years after head injury: case report. Surg Neurol 1994; 42: 65-69
  • 64 Nedd K, Sfakianakis G, Ganz W et al. 99 mTc-HMPAO SPECT of the brain in mild to moderate traumatic brain injury patients: compared with CT – a prospective study. Brain Inj 1993; 7: 469-479
  • 65 Okamoto H, Harada K, Yoshimoto H et al. Acute epidural hematoma caused by contrecoup injury. Surg Neurol 1983; 20: 461-463
  • 66 O’Neill OR, Delashaw JB, Phillips JP. Subperiosteal hematoma of the orbit associated with subfrontal extradural hematoma: case report. Surg Neurol 1994; 42: 308-311
  • 67 Owler BK, Besser M. Extradural hematoma causing venous sinus obstruction and pseudotumor cerebri syndrome. Childs Nerv Syst 2005; 21: 262-264
  • 68 Paterniti S, Fiore P, Macri E et al. Extradural haematoma. Report of 37 consecutive cases with survival. Acta Neurochir (Wien) 1994; 131: 207-210
  • 69 Pereira CU, Leão JDBC, Ribas A et al. Frontal epidural haematoma. Analysis of 30 cases. J Bras Neurocirurg 2004; 15: 18-21
  • 70 Pillay R, Peter JC. Extradural haematomas in children. S Afr Med J 1995; 85: 672-674
  • 71 Pozzati E, Frank F, Frank G et al. Subacute and chronic extradural hematomas: a study of 30 cases. J Trauma 1980; 20: 795-799
  • 72 Pozzati E, Staffa G, Nuzzo G et al. Late recurrence of bleeding in a chronic extradural hematoma. J Trauma 1987; 27: 579-580
  • 73 Pringle JH. Traumatic meningeal haemorrhage, with a review of seventy-one cases. Edinb Reed J 1938; 45: 741-760
  • 74 Rappaport ZH, Shaked I, Tadmor R. Delayed epidural hematoma demonstrated by computed tomography: case report. Neurosurgery 1982; 10: 487-489
  • 75 Reale F, Delfini R, Mencantini G. Epidural hematomas. J Neurosurg Sci 1984; 28: 9-16
  • 76 Rice JO, Walters C, Olson RE et al. Epidural hematoma after minor oral trauma. J Oral Surgery 1976; 34: 639-641
  • 77 Rivas J, Lobato R, Sarabia R et al. Extradural hematoma: analysis of factors influencing the courses of 161 patients. Neurosurgery 1988; 23: 44-51
  • 78 Robertson JH, Clark WC, Acker JD. Bilateral occipital epidural hematomas. Surg Neurol 1982; 17: 468-472
  • 79 Romano TA, Walzer SI, Krivoy OS et al. Ipsilateral exophthalmos due to subfrontal epidural hematoma. Surg Neurol 1983; 19: 77-79
  • 80 Saiful MN, Azmi A, Saffari MH. Proptosis presenting as a delayed sign of frontal extradural haematoma. Med J Malaysia 2007; 62: 156-157
  • 81 Seelig JM, Marshall LF, Toutant SM et al. Traumatic acute epidural hematoma: unrecognized high lethality in comatose patients. Neurosurgery 1984; 15: 617-620
  • 82 Servadei F, Faccani G, Roccella P et al. Asymptomatic extradural haematomas. Results of a multicenter study of 158 cases in minor head injury. Acta Neurochir (Wien) 1989; 96: 39-45
  • 83 Sinha AK, Paznar C, Ahmed S et al. Spontaneous resolution of a small extradural haematoma in a child. Cen Eur Neurosurg 2009; 70: 52-54
  • 84 Sparacio RR, Khatib R, Chiu J et al. Chronic epidural hematoma. J Trauma 1972; 12: 435-439
  • 85 Stephanov S, de Preux J. Acute subfrontal epidural hematoma: report of two cases. Surg Neurol 1992; 37: 329-331
  • 86 Stewart CR, Salmon JF, Domingo Z et al. Proptosis as a presenting sign of extradural haematoma. Br J Ophthalmol 1993; 77: 179-180
  • 87 Sullivan T, Jarvik J, Cohen W. Follow-up of conservatively managed epidural hematomas: implications for timing of repeat CT. AJNR Am J Neuroradiol 1999; 20: 107-113
  • 88 Šulla I, Vanicky I. Experience with frontoparietal craniotomy in a dog. An experimental model and possible clinical implications. Folia Veterinaria 2003; 47: 95-98
  • 89 Tatagiba M, Sepehrnia A, el Azm M et al. Chronic epidural hematoma-report on eight cases and review of the literature. Surg Neurol 1989; 32: 453-458
  • 90 Uzan M, Yentur E, Hanci M et al. Is it possible to recover from uncal herniation? Analysis of 71 head injured cases. J Neurosurg Sci 1998; 42: 89-94
  • 91 Watanabe T, Nakahara K, Miki Y et al. Chronic expanding epidural haematoma. Case report. Acta Neurochir (Wien) 1995; 132: 150-153
  • 92 Watts C. Exophthalmos and epidural hematoma. South Med J 1976; 69: 1539-1553
  • 93 Wood RL, Eames R. Application of behaviour modification in the rehabilitation of traumatically brain-injured patients. In: Davey G. ed. Applications of Conditioning Theory. New York: Methuen; 1981: 81-101
  • 94 Zuccarello M, Fiore DL, Pardatscher K et al. Chronic extradural hematoma. Acta Neurochir (Wien) 1983; 67: 57-66