Conservative management of significant supratentorial epidural hematomas in pediatric patients

Document Type



Medical College Pakistan


Background Radiologically significant epidural hematomas
are generally treated with craniotomy and evacuation.
However, pediatric patients with such hematomas may have
normal neurological examinations. We aim to report the presenting
features, management, and outcomes of pediatric patients
who underwent conservative management of such hematomas
at our center and also show that serial neurological
examinations are a safe and effective way of managing these

Methods A retrospective review of pediatric patients with
extradural hematoma (EDH) thickness of at least 1 cm and
who were conservatively managed was performed. All patients
were followed up in neurosurgery outpatient clinics after
discharge at 1-month, 3-month, 6-month, and 1-year intervals.
Detailed neurological examination was performed at each
visit, and a standardized questionnaire was also used to document
the parent’s subjective opinion of the patient’s quality
of life.

Results A total of 17 patients satisfied the study criteria and
were included. Conservative management was successful in
15 patients, while a craniotomy with evacuation of hematoma
had to be performed in two patients. All patients had a GOS
score of 5 on 1-year follow-up, had normal schooling, and
reported complete satisfaction with the management protocol.

Conclusion Conservative treatment is an optimal treatment
option, and patients can be followed safely using a protocol
of serial neurological examinations. A center must have resources
to perform a craniotomy with evacuation of EDH in
case of neurological worsening and be able to provide trained
staff to carry out serial neurological examinations before
treating these patients conservatively.


Child's Nervous System