The Peculiarities of Clinical Course and Approaches to Surgical Treatment of Patients with Epidural Hematoma in Isolated Traumatic Brain Injury
Traumatic brain injury (TBI) is currently one of the main causes of death and disability in the population in the most countries of the world, relevant medical and social problem. According to the literature, incidence of epidural hematomas (EH) varies in the range of 1 to 4.8 % among those who suffered a severe brain injury. The prognosis and outcomes of EH depend on many factors: the size and localization of hematoma, the source of bleeding and pace of development by compression of the brain, and severity of associated damage, age and aggravated history of patient, the term of diagnosis and surgery, organization and quality of medical assistance.
The aim is to study the peculiarities of clinical course and approaches to surgical treatment of patients with EH and isolated TBI, to develop new approaches for improving outcomes of surgery for EH.
A retrospective analysis has been performed, the reliability of the presented material is estimated using the method of parametric statistics. 188 medical records of patients with isolated traumatic brain injury were studied, they were operated in various hospitals of Republic of Armenia. EH were detected in 83 (44.1 %) patients. Patients were divided into 3 groups on the basis of the stage of the clinical course of the head injury. 41 (49.4 %) individuals were in the first group, they were at the stage of subcompensation, 25 (30.12 %) — in the second group, they had moderate decompensation stage, 17 (20.48 %) — in the third group, they had gross decompensation stage. Operative intervention is made at different periods after the admission of patients within 1–24 hours. Four patients were reoperated. Three (3.6 %) patients died, 13 (15.7 %) were discharged with gross neurological deficit.
Conclusions. The patients with isolated TBI often operated due to the EH. The most of them are people of working age. EH has a relatively favorable clinical course: the majority of patients hospitalized in the stage of subcompensation of clinical course of TBI. EH may develop in patients with depressed skull fractures, which can be determined by CT scan. Admission of patients at the stage of gross decompensation, lack of treatment in the prehospital period, a diagnostic error, delay in operation, hospitalization later than one day after the head injury had a negative effect on the surgical treatment. The patient with isolated TBI should be examined using CT scan and operated in the first hours after admission, if EH would be detected by CT scan. CT dynamic monitoring should be done in the preoperative period during 10–12 hours, if subarachnoid hemorrhage or meningeal hematoma was detected at the primary CT scan. In the postoperative period, intensive therapy should significantly reduce possibility of cerebral and extracerebral complications.
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