Riaz-ur Rehman, Mushtaq, Shahid Ayoob, Mewat Shah, Asad Nabi.
Management of Supratentorial extradural hematoma secondary to head trauma in pediatric patients admitted in tertiary care hospital.
Pak J Surg Jan ;30(3):231-5.

Objective: To know the surgical outcome of Supratentorial extradural hematoma (EDH) secondary to head trauma in pediatric patients Materials and methods: Th is Retrospective study was conducted in Department of Neurosurgery, Hayatabad Medical Complex Peshawar, from July 2009 to June 2013. All pediatrics under 16 years patients with EDH who were having altered consciousness with hematoma size more than 20 ml, volume of the epidural hematoma 30 ml even in neurologically intact and EDH in temporal lobe the hematoma of 20 ml size was considered for surgical evacuation .Patients with spontaneous EDH , EDH in the posterior cranial fossa or patients who refused to be enrolled in this study were excluded from current study. All the patients who required surgical treatment were operated on emergency basis and craniotomy was done. Outcome was assessed using Glasgow outcome scale. Th e data was collected on separate performa and the results were analyzed by using SPSS version 16. Results: Total 84 patients were enrolled in the present study. Out of these, 58 were boys 26 were girls. Th e boys and girls ratio was 2.23:1. Age ranged from 7 months to 16 years with a mean age of 9.42 years. Th e commonest mode of injury was fall from height 39.28% (n=33) followed by road traffi c accident (RTA) 33.33% (n= 28). Assault was the cause in 18 patients (21.83%) and various other causes in 5 (5.59%) patients. Th e commonest presentation was impaired consciousness (n=50), followed by Headache (n=47). Aside from these 20.24% (n=17) patients had focal neurological defi cit. Early seizures were documented in (n=10) EDH patients. Lucid interval was seen in (n=22) patients. Associated brain edema was present in 35.71% (n= 30). Concomitant skull fracture was found in 59.52% (n=50). Intracerebral hematoma was seen in 20(23.81%) patients and subdural hematoma in 4(4.76%) patients. EDH was located temporoparietal region in 41.67% (n = 35), followed by frontal and parietal region in 28.57% (n = 24) and 13.09 % (n=11) respectively and temporal region in 19 (22.62%) patients . Mortality rate was 5.95 % (n=5) aft er surgery. Conclusion: Epidural hematoma in children is one of the most rewarding neurosurgical emergencies amongst head injuries patients but early recognition and prompt management is vital. Several factors aff ect the ultimate outcome of extradural hematoma surgery which include associated brain lesions like sever brain edema, subdural hematoma, pre-operative neurology of patient and intra cerebral hematoma.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com