Epidural hematoma - benign or potentially malignant disease?

INTRODUCTION: Epidural hematoma (EDH) is generally considered to be a condition with a good prognosis. However, postoperative results of numerous studies have shown that mortality and morbidity remain relatively high. The aim of our article is to evaluate surgical outcomes in patients undergoing EDH evacuation over the last five years.

METHODS: Data were analysed retrospectively. Pre-operative GCS was assessed. Location and incidence of associated head injuries were recorded. Two groups were established: 1. "immediate-care-requiring" and "followed-up" patients. Time interval CT - surgery was measured in the first group and the number of CT scans in the second group. Complications were divided into general and surgical. Outcome was evaluated on GOS.

RESULTS: 67 patients underwent the surgery. At admittance, GCS was 13-15 in 55%, 9-12 in 8% and 3-8 in 37% of the patients. EDH was mostly located in the temporal region - in 52%. Associated head injuries occurred in 76%. Mean interval CT - operation lasted 2h 15min in the first group. Two pre-operative CT scans were done in 88% of the patients in the second group. General complications occurred in 34% and surgical in 15%. Mortality rate was 6%. 20% of the patients had a GOS of 1-3 and 80% of them had a GOS of 4-5.

CONCLUSION: Our results have shown that morbidity and mortality after EDH evacuation are still relatively high. 14% of the patients remained disabled, and 6% died. The outcome depends mostly on preoperative clinical picture and timing of the surgery. Key words: epidural hematoma - evacuation - neurological outcome - timing of the surgery.