Conservative management of extradural hematoma: A report of sixty-two cases

Background: Extradural hematomas (EDH) are considered life threatening in that the risk for brain herniation is significant. The current accepted understanding within the literature is to treat EDH via surgical evacuation of the hematoma.

Cases: In this case-series we report 62 cases of EDH managed conservatively without surgical intervention. Inclusion criteria were: Glasgow comma scale score 13-15, extradural hematoma confirmed by CT being less than 40 mm, less than 6 mm of midline shift, and no other surgical lesions present. Patients were initially observed in a surgical intensive care unit prior to discharge and had closely scheduled follow-up.

Results: Of the 62 cases none required emergent intervention and the majority had interval resolution of the epidural hematoma over time. Resolution was apparent by 21 days and definitive by 3 to 6 months.

Conclusion: Patients with EDH who have a high Glasgow comma scale score 13-15, volume <40 mm, and less than 6 mm of midline shift should be considered for conservative management. Our study indicates that these patients will have interval resolution of hematoma over time without worsening of symptoms.