Hématomes intra-crâniens extra-duraux : à propos de 100 cas récents

Biochemical effects of experimental epidural hematoma on brain parenchyma of rats

INTRODUCTION

The management of epidural hematoma is classified into surgical or conservative treatment according to clinical and radiologic parameters. In the recent years, the number of paper suggesting conservative management has been increasing. The experimental works that have been performed are based on especially the effects of epidural hematomas. Basic pathophysiologic factors on ischemia result of brain trauma are based on biochemical mediators. Nitric oxide (NO) and malondialdehyde (MDA) are the substances that play important roles in brain damage after trauma.

MATERIAL AND METHOD

In this study, 36 rats are divided into three groups (n = 12/group). Epidural hematoma was achieved by 0.1 ml autolog blood in rat epidural space with balloon model. Early and late phase biochemical effects on parenchyma of epidural hematoma operated in a volume which neither alters intracranial pressure (ICP) nor creates shift effect were observed. Biochemical changes of NO and MDA levels were examined in each of three experimental groups.

RESULTS

NO values increased significantly in the early group (6 hours) compared with those in the control group. Difference of NO values between the control and late groups was not significant. An increase has been found in MDA values in the control group compared with those in the early group. MDA values of the late group (30 days) were closer to that of the control group.

CONCLUSION

In this study, considering biochemical results, we have found that conservative volumes which neither increase ICP nor cause brain shift do not lead to permanent changes on brain.

Efficacy of subdural saline injection during surgery for acute epidural haematomas

PRIMARY OBJECTIVE

The purpose of this study was to investigate the efficacy of subdural space saline injection surgery in the management of large acute epidural haematomas (EDHs).

METHODS AND PROCEDURES

Over a period of 6 years, the authors employed the technique of subdural space saline injection to facilitate elevation of dura after evacuation of supratentorial epidural haematomas. MAIN OUTCOMES AND RESULTS. Eighty patients with supratentorial epidural haematomas underwent the procedure. Infusion of saline in the subdural space not only helps elevation of the dura, facilitate haemostasis and application of suspension stitches during operation, it also avoids ICP fluctuations during the operations. Post-operative CT scans showed rapid disappearance of saline and reposition of cerebral structure. No patient required re-operation for residual haematoma.

CONCLUSIONS

Subdural saline injection is an effective operative technique in the management of large epidural haematoma.

The role of surgery in traumatic brain injury

PURPOSE OF REVIEW

To identify the surgical indications in the treatment of posttraumatic intracranial hematomas and to evaluate the role of external decompression in severe posttraumatic intracranial hypertension.

RECENT FINDINGS

An evidence-based review resulted recently in the publication of Guidelines for Surgical Management of Traumatic Brain Injury. Unfortunately all published surgical studies are at the level of simple options with no standards. We know that a number of patients harbouring small epidural/subdural hematomas can be managed conservatively when the lesions are less than 10 mm of thickness and with a midline shift of less than 5 mm. With exception of these few cases, the current practice is that a large number of patients with posttraumatic hematomas are operated either within 24 h from injury (with acute subdural hematomas as the prevailing lesion) or later (with parenchymal hematomas as the prevailing lesion). According to a recent European study, about one third of these patients are also decompressed.

SUMMARY

A surgical approach is frequent in posttraumatic intracranial hematomas in spite of a low level of evidence. One of the surgical options either in association with hematoma evacuation or in isolation is the technique of bone flap decompression.