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Daoud SS, Jamous MA, Al Barbarawi MM, Jarrar S, Jaradat A, Aljabali AS, Altal MK, Hulliel AF, Hazaimeh EA, Jbarah OF, Alsharman MA, Abdallah A. Operative versus non-operative management of posterior fossa epidural hematoma: A systematic review and meta-analysis. Neurochirurgie 2024; 70:101578. [PMID: 38943702 DOI: 10.1016/j.neuchi.2024.101578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/30/2024] [Accepted: 06/01/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Posterior fossa epidural hematoma (PFEDH) is rare, occurring in less than 3% of head injuries. It can be managed either operatively or non-operatively. Management guidelines date from 2006, without recent updates providing class III evidence. METHOD We searched PubMed and other databases for English language observational studies up to 2021 that compared the two treatment approaches for PFEDH and. RESULTS Twenty-four of the 350 references, for involving 874 patients, met the study criteria. Conservative management showed higher GOS 5 scores and lower mortality. GCS 13-15 patients were more prevalent in the conservative group. Surgical cases often involved ventriculomegaly/compression, hydrocephalus or contusion. CONCLUSION The study shed light on surgical versus conservative PFEDH management, although evidence is sparse. Generally, conservative methods showed better initial outcomes, and should be preferred. However, respect of individual patient traits and Brain Trauma Foundation guidelines is crucial: conservative management may not suit all cases. To enhance the evidence base, RCTs are important for optimal PFEDH management. Bridging this gap can substantially improve patient outcomes and clinical decision-making, emphasizing the need to consider both the available evidence and patient-specific factors for effective guidance.
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Affiliation(s)
- Suleiman S Daoud
- Assistant Professor of Neurosurgery, Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan.
| | - Mohammad A Jamous
- Professor of Neurosurgery, Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
| | - Mohammed M Al Barbarawi
- Professor of Neurosurgery, Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
| | - Sultan Jarrar
- Assistant Professor of Neurosurgery, Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
| | - Amer Jaradat
- Assistant Professor of Neurosurgery, Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
| | - Ahmed S Aljabali
- Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
| | - Mohammad K Altal
- Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
| | - Atef F Hulliel
- Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
| | - Ethar A Hazaimeh
- Neurology Department, Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
| | - Omar F Jbarah
- Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
| | - Mohammad A Alsharman
- Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
| | - Adam Abdallah
- Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, PO Box 3030 zip code 22110, Irbid, Jordan
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Lange M, Kramer S, Voll C, Corbacioglu S. Sturz vom Wickeltisch. Monatsschr Kinderheilkd 2023. [DOI: 10.1007/s00112-023-01712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Wilhelmy F, Wende T, Kasper J, Ablefoni M, Bode LM, Meixensberger J, Nestler U. Rapid resolution of a traumatic venous epidural hematoma in a 3-year-old child: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21413. [PMID: 36060428 PMCID: PMC9435549 DOI: 10.3171/case21413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Posterior fossa epidural hematoma rarely occurs in children after traumatic head injury. There is ongoing discussion about appropriate treatment, yet the radiological features regarding the time to resorption of the hematoma or required follow-up imaging are rarely discussed.
OBSERVATIONS
The authors presented the case of a 3-year-old child who was under clinical observation and receiving analgetic and antiemetic treatment in whom near-complete hematoma resorption was shown by magnetic resonance imaging as soon as 60 hours after diagnosis. The child was neurologically stable at all times and showed no deficit after observational treatment. Hematoma resorption was much faster than expected. The authors discussed hematoma drainage via the sigmoid sinus.
LESSONS
Epidural hematomas in children can be treated conservatively and are resorbed in a timely manner.
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