www.jkns.or.kr http://dx.doi.org/10.3340/jkns.2012.51.4.215 J Korean Neurosurg Soc 51 : 215-218, 2012 Print ISSN 2005-3711 On-line ISSN 1598-7876 Copyright © 2012 The Korean Neurosurgical Society Clinical Article Our Experience with Surgically Treated Epidural Hematomas in Children Sang-Won Jung, M.D., Dong-Won Kim, M.D., Ph.D. Department of Neurosurgery, Keimyung University School of Medicine, Daegu, Korea Objective : Traumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on peri- od and region of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-relat- ed variables in a large consecutive series of surgically treated EDH in children. Methods : This is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients’ medical re- cords, computed tomographic (CT) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe extracranial injury, abnormal pupillary response, hematoma thickness, se- verity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury. Results : The mean (SD) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cas- es, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hema- toma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI re- vealed brain contusion in 5 patients, and diffuse axonal injury in one patient. The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance. Conclusion : Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent. Key Words : Traumatic epidural hematomas (EDHs) · Children · Cause · Outcome. INTRODUCTION Acute epidural hematomas (EDHs) in children and infants represent a potentially life-threatening condition after head inju- ry. EDHs in children are a relatively unusual occurrence. The re- ported incidence of EDH ranges between 1% and 6% after head trauma in hospitalized children5,10). Early identification and ade- quate management depending on the patient’s clinical condition and the size of EDH are prerequisites for good outcome10). How- ever, besides the presence of midline structure shift on head computed tomographic (CT) scan and clinical signs of uncal herniation, other factors, such as associated brain contusion, dif- fuse axonal injury (DAI), or extracranial injury, may determine the outcome of the children. Also, the causes and outcomes of acute EDHs vary depending on period and region. The aims of this analysis were to review the cause and outcome of surgically treated pediatric EDHs in our hospital and to discuss outcome- related variables in a large consecutive series of surgically treated EDH in children for 10 years. MATERIALS AND METHODS Patient population A total of 175 children were admitted with head trauma be- • Received : November 18, 2011 • Revised : March 21, 2012 • Accepted : April 15, 2012 • Address for reprints : Dong-Won Kim, M.D., Ph.D. Department of Neurosurgery, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea Tel : +82-53-250-7333, Fax : +82-53-250-7356, E-mail : dongwon@dsmc.or.kr • This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 215