Pediatrik Yaş Grubunda Hafif Semptomatik Büyük Ekstradural Hematomların Konservatif Tedavisi: 20 Vaka Serisi

Amaç: Pediatrik yaş grubunda görülen asemptomatik veya hafif semptomatik ekstradural hematomu olan hastalarda konservatif tedavi cerrahi tedaviye güvenli bir alternatiftir. Hasta seçim kriterleri hakkında hala bir tartışma vardır. Bu çalışma, ameliyatsız tedavi edilen pediatrik büyük EDH hastalarının radyolojik ve klinik özelliklerini vurgulamaktadır. Gereç ve Yöntemler: Bu retrospektif-kohort çalışmada, Sağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi'nde 2015-2020 yılları arasında tedavi gören 20 pediatrik EDH hastasının verilerinin bir derlemesini sunuyoruz. Bu çalışma; Glasgow Koma Skalası (GCS) 14+ olan ve bilgisayarlı tomografide (BT) EDH kalınlığı ≥ 15 mm olan hastaları, tedavi protokolünü ve sonuçlarını içermektedir. Bulgular: EDH tanısı konan 206 hastanın 131'inde (%63,5) başlangıç GCS ≥ 14 idi. Ayrıca 23'ünde (%11,1) EDH kalınlığı ≥ 15 mm idi. Acil cerrahi nedeniyle 3 hasta çalışma dışı bırakıldı. Çalışmaya dahil edilen hasta sayısı 20 idi ve tüm hastaların en az bir yıllık takipte GOS skoru 5 idi. Sonuç: Sonuçlarımıza göre, pediatrik büyük EDH hastalarında konservatif tedavi cerrahi tedaviye optimal bir alternatiftir. Ancak hasta seçimi ve klinik özellikler çok önemlidir.

Conservative Treatment of Mildly Symptomatic Large Extradural Hematomas in The Pediatric Age Group: A Report of 20 Cases

Aim: Conservative treatment is a safe alternative to surgical treatment in patients with asymptomatic or mildly symptomatic extradural hematoma seen in the pediatric age group. There is still a debate about patient selection criterias. This study highlights the radiological and clinical features of pediatric large EDH patients treated without surgery. Material and Methods: In this retrospective-cohort study, we present a review of the data of 20 pediatric EDH patients treated in Health Sciences University, Bursa Yüksek Ihtisas Training and Research Hospital between 2015 and 2020. This study; includes patients with Glasgow Coma Scale (GCS) 14+ and diagnosed EDH thickness ≥ 15mm in computed tomography (CT), treatment protocol and outcomes. Results: Of the 206 patients diagnosed with EDH, 131 (63,5 %) had an initial GCS ≥ 14. Furthermore, 23 (11,1 %) patients had EDH thickness ≥ 15 mm. 3 patients were excluded from study because of emergent surgery. The number of patients included in the study was 20 and all patients had a GOS score of 5 on at least one -year follow-up. Conclusion: According to our results, conservative treatment is an optimal alternative to surgical treatment in pediatric large EDH patients. However, patient selection and clinical features are very important.

PDF

___

1. Cheung PS, Lam JM, Yeung JH, Graham CA, Rainer TH. Outcome of traumatic extradural hematoma in Hong Kong. Injury 2007;38: 76–80.
2. Jamous MA, Samara QA, Jbarah OF, Ahmed YB Management of traumatic posterior fossa epidural hematomas in pediatrics: our experience and review of the literature. Childs Nerv Syst. 2021 Sep;37(9):2839-2846
3. Call L, Qiu Q, Morris J, Flaherty B, Vavilala MS, Mills B, Bratton S, Mossa-Basha M. Characteristics of pediatric patients with traumatic epidural hematomas who can be safely observed: a clinical validation study Br J Radiol. 2020 Oct 1;93
4. Chen C, Shi J, Rachel MS, Sribnick EA, Groner JI, Xiang H. U.S. trends of ED visits for pediatric traumatic brain injuries: implications for clinical trials. Int J Environ Res Public Health 2017;14(414).
5. Khan MB, Riaz M, Javed G. Conservative management of significant supratentorial epidural hematomas in pediatric patients. Childs Nerv Syst 2014; 30: 1249–1253.
6. Pang D, Horton JA, Herron JM, Wilberger JE Jr, Vries JK. Nonsurgical management of extradural hematomas in children. J Neurosurg 1983; 59: 958–971.
7. Champagne PO, He KX, Mercier C,Weil AG, Crevier L. Conservative Management of Large Traumatic Supratentorial Epidural Hematoma in the Pediatric Population. Pediatr Neurosurg 2017;52(3):168-172.
8. Bullock R, Smith RM, van Dellen JR. Non-operative management of extradural hematoma. Neurosurgery 1985; 16:696-700.
9. Royal College of Surgeons of England Trauma Committee: A Position Paper on the Acute Management of Patients with Head Injury. Ann R Coll Surg Engl. 2005; 87:323–5.
10. Van Ornam J, Pruitt P, Borczuk P. Is repeat head CT necessary in patients with mild traumatic intracranial hemorrhage Am J Emerg Med. 2019 Sep;37(9):1694-1698
11. Siegel MJ, Curtis WA, Ramirez JC. Effects of Dual-Energy Technique on Radiation Exposure and Image Quality in Pediatric Body CT. AJR Am J Roentgenol. 2016:1-10.
12. Spazzapan P, Krašovec K, Velnar T Risk factors for bad outcome in pediatric epidural hematomas: a systemic review. Chin Neurosurg J. 2019 Aug 8; 5:19
13. Chen TY, Wong CW, Chang CN, Lui TN, Cheng WC, Tsai MD, et al. The expectant treatment of ‘asymptomatic’ supratentorial epidural hematomas. Neurosurgery 1993;32:176-179.
14. Bejjani GK, Donahue DJ, Rusin J, Broemeling LD. Radiological and clinical criteria for the management of epidural hematomas in children. Pediatr Neurosurg 1996;25:302-308.
15. Bounajem MT, Samples DC, Wallace DJ, Tavakoli S, Liao L,Trasiewicz I. Management of epidural hematomas in pediatric patients presenting with a GCS of 14 or better. J Clin Neurosci 2019;70:118-122.
16. Balmer B, Boltshauser E, Altermatt S, Gobet R. Conservative management of significant epidural haematomas in children. ChNS. Off J International Soc Pediatr Neurosurg 2006; 22: 363–367.
17. Flaherty BF, Loya J, Alexander MD, Pandit R, Torres RA, et al. Utility of clinical and radiographic findings in the management of traumatic epidural hematoma. Pediatr Neurosurg 2013;49(4):208-14.
18. Yang J,Peek-Asa C, Allareddy V, Phillips G, Zhang Y, Cheng G. Patient and hospital characteristics associated with length of stay hospital charges for pediatric sports-related injury hospitalizations in the United States, 2000-2003. Pediatrics 2007;119(4):813-820.
19. Jamous MA, Aziz HA, Kaisy FA, Eloqayli H, Azab M,Al-Jarrah M. Conservative management of acute epidural hematoma in a pediatric age group. Pediatr Neurosurg 2009;45(3):181-4.
20. Knuckey NW, Gelbard S, Epstein MH. The management of asymptomatic epidural hematomas: a prospective study. J Neurosurg 1989; 70: 392–396.
21. Narayan RK, Wilberger JE, Jr Povlishock JT. Neurotrauma. 1st ed. New York: McGraw Hill; 1996.
22. Samples DC, Bounajem MT, Wallace DJ, Tarasiewicz I. Role of follow- up CT scans in the management of traumatic pediatric epidural hematomas. Child's Nervous System 2019 Nov;35(11):2195-2203.
23. Tuncer R, Kazan S, Ucar T, Acikbas C, Saveren M. Conservative management of epidural haematomas. Acta Neurochir 1993; 121:48– 52.
24. Shivender S, Manuranjan G, Ragh H, Naraya G, Ajay C. Clinico- radiological Correlation with Outcome in Traumatic Pediatric Extradural Hematoma: Institutional Experience J Pediatr Neurosci. 2021 Apr-Jun; 16(2): 113–118.
25. Cohen-Salmon D. Perioperative psychobehavioural changes in children. Ann Fr Anesth Reanim 2010; 29(4):289-300.
26. O’Brien D. Acute postoperative delirium: definitions, incidence, recognition, and interventions. J Perianesth Nurs 2002; 17(6): 384-92.
27. Kain ZN, Maranets I, McClain B, Gaal D, Mayes LC. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg 2004; 99(6): 1648-54.