Clinical course of epidural hematoma with isolated traumatic brain injury and its surgical treatment

Abstract

The peculiarities of the clinical course of epidural hematoma (EH) with isolated traumatic brain injury (TBI) are studied and new approaches for improving EH outcomes in the surgical treatment are developed. The retrospective analysis was performed. 188 medical records of patients with isolated traumatic brain injury (ITBI), who were operated in various hospitals of the Republic of Armenia, were studied. EH's were detected in 83 patients. The patients with ITBI were often operated because of EH. Most of them are the persons of working age. EH has a relatively favorable clinical course: the majority of patients were hospitalized at the stage of sub-compensation of the clinical course of TBI. EH may develop in patients with depressed skull fractures that can be determined by CT scan. The reception of patients at the stage of rough decompensation, the lack of treatment in the pre-hospital period, a diagnostic error, the delay in operation, the hospitalization later than one day after the head injury had a negative effect on the surgical treatment. The patient with ITBI should be examined by CT scan and operated during the first hours after his reception, if EH would have been detected by CT scan. CT dynamic monitoring should be arranged in the pre-operative period during 10-12 h, if suba-rachnoid hemorrhage or meningeal hematoma was detected at the primary CT scan. In the post-operative period, the intensive therapy should significantly reduce the possibility of cerebral and extracerebral complications.