Surgical Management of Acute Epidural Hematomas

Indications for surgery An epidural hematoma (EDH) greater than 30 cm3 should be surgically evacuated regardless of the patient's Glasgow Coma Scale (GCS) score. An EDH less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift (MLS) in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic (CT) scanning and close neurological observation in a neurosurgical center. Timing It is strongly recommended that patients with an acute EDH in coma (GCS score Methods There are insufficient data to support one surgical treatment method. However, craniotomy provides a more complete evacuation of the hematoma.