Ashraf Shaheen, Farrukh Raza, Abdul Majid, Laeeq Ahmed, Manzoor Ahmed.
Review of Surgical Management of Supratentorial Extra Dural Haematoma at LGH.
Pak J Neuro Surg Jan ;14(2):96-103.

Introduction: Care of the head injured patient forms an important part of a neurosurgeon’s work in all countries, and especially in developing countries, like ours. With increasing industrialization, increase in road traffic accidents, the incidence and severity of head injury is increasing. Of all the potentially lethal compli-cations of head injury, extradural haematoma (EDH) is the most readily diagnosed and remediable.The Objectives: To review the surgical management of Supratentorial EDH, at our Department. Study Design: Retrospective Review. Setting: Department of Neurosurgery, Lahore General Hospital / PGMI, Lahore. Materials and Methods: This is a retrospective case series of 1536 patients of Supratentorial EDH who were treated surgically between Jan 2005 and Dec 2009. Patients' medical records were reviewed to define variables associated with outcome at the time of discharge. Variables included in the analysis were time since injury, age, gender, severity of head injury, anatomical site of hematoma on CT scan and outcome at the time of discharge (Glasgow Outcome Scale). Patients harbouring extra-cranial injuries which required operative management by other departments, e.g. laprotomy, thoracotomy, chest intubation and cases having associated brain parenchymal injury requiring intervention, were excluded.Results: In our study of 1536 patients the mean age was 20.46 years, the minimum age was 5 and maximum 60 years. The age range was 55 years. Out of the total 1536 patients 1068 i.e. 69.5% were male and only 468 i.e. 30.5% were females. Male to female ratio was 2.29 : 1. Patients presenting with Mild Injury was the largest group. 664 out of 1536 (n) i.e. 43.2% were having a score of GCS from 13 – 15. The 2nd was patients with GCS score 9 – 12 i.e. moderate injury groups. 516 out of 1536 (n) i.e. 33.6%, presented with GCS Score ranging from 9 – 12. Patients having severe head injury, presenting with GCS from 3 – 8 was the smallest group. Only 356 out of 1536 (n) i.e. 23.2% were in this group. In Majority of the patients’ time since injury was from 6 to 12 hours, i.e. 732 out of 1536 (n) making 47.7%. Patients reaching within 6 hours were the 2nd largest group, i.e. having 485 patients making 31.6% of the total n = 1536. Only 319 patients i.e. 20.8% were those who reached after 12 hours of injury. As of the site of EDH, in our study of 1536 patients, Frontal region Hematomas was the most frequent ones. 406 out of the total 1536 (n) i.e. 26.4% Hematomas operated in our study was at frontal region. Tempo-Parietal was the 2nd largest group having 347 patients i.e. 22.6% of the total 1536 (n) EDH’S operated. Fronto-Parietal region was the 3rd frequent site having 194 patients i.e. 12.6% of n = 1536. Parietal location was the 4th frequent in order of frequency having 156 patients i.e. 10.2% (n = 1536). There were 122 patients out of 1536 (n) i.e. 7.9% having Occipital location of the EDH. Only 90 patients out of 1536 (n) i.e. 5.9% were having temporal Hematomas in our study. Patients having large Fronto-Parieto-Temporal Hematomas were only 5.5% i.e. 84 outof 1536 (n). At 1 week Post-Operatively 738 patients out of 15360 (n) i.e. 48 % were having Good Recovery. 491 out of 1536 (n) i.e. 52% were in Moderate Disability group. 236 out of 1536 (n) i.e. 20% patients were severe disability group when assessed with Glasgow Outcome Scale. 71 out of 1536 (n) i.e. 4.6% were dead.Conclusions: The surgical management of EDH is a rewarding and life saving procedure and young male population seems to be a vulnerable population group.

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