J Korean Neurosurg Soc 51 | April 2012 20 15 10 5 0 Bicycle Motor and car Pedetrian hit Traffic accident Fall down Slip down Birth injury Unknown Fig. 1. Cause of pediatric EDHs. EDHs : epidural hematomas. Value 109 12.9 Table 1. General characteristic of 29 patients Index Age (months) GCS score Sex (M : F)* Male 19 Female 10 Mean time to surgery (hours) 23 (range 3-122) Abnormal pupil finding* 2 Radiologic finding Thickness of hematoma (mm) 18 (range 5-40) Skull fracture* 24 Midline shifting* 14 Heterogeneity of hematoma nature* 20 Enlargement of hematoma thickness* 6 Contusion* 5 Diffuse axonal injury* 1 *Values represent the number of patients, unless otherwise indicated. GCS : glasgow coma scale tween Jan 2000 and Feb 2010. There were 57 patients with EDHs. Among 57 patients, 29 patients with EDH were surgically treat- ed. All patients were documented in a database at the time of treatment. Perioperative course, radiological findings, and out- come were evaluated retrospectively. Items included in the da- tabase were demographic features, cause of trauma, preopera- tive clinical status according to the Glasgow Coma Scale (GCS) score, signs of transtentorial herniation (unilateral or bilateral dilated pupil), isolated head injury or associated substantial ex- tracranial injury, time to treatment (including the reason for delayed treatment, if performed), and the outcome according to the modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS). The outcome was classified as excellent (mRS score, 0; GOS score, 5), good (mRS score, 1.2; GOS score, 4), or adverse (mRS score ≥3; GOS score ≤3). trauma life support protocol if presented immediately to the emergency department of our institution. Trauma workup was initiated according to the clinical status and the mechanism of the trauma and usually included a head and body CT scan and abdominal ultrasound. After documentation of an EDH treat- ment, indication for surgery was a thickness of the hematoma of at least 10 mm (maximal thickness), dislocated skull frac- tures associated with EDH, or a documented increase of the he- matoma size with clinical deterioration. Operative treatment of EDH was performed as a standardized procedure. After osteo- plastic craniotomy, hematoma evacuation was performed. Any craniotomy performed more than 10 hours after injury was classified as “delayed”. All patients underwent either postopera- tive cranial CT or magnetic resonance imaging (MRI) to docu- ment adequate removal of the hematoma, trauma-associated brain contusion, or any complication related to the trauma or operative treatment. MRI was the preferred method of control imaging whenever DAI was suspected from the severity and mechanism of trauma. Statistical analysis Comparisons of demographic variables including age at trau- ma, isolated head injury, unilateral or bilateral dilated pupil, se- vere head injury (GCS <8) before treatment, hematoma size, presence of brain contusion, and time to operative evacuation between the groups were performed using unpaired t-test, χ2 test. Values of p<0.05 were considered significant. RESULTS General characteristics Twenty-nine patients with EDH were surgically treated in study period. Age ranged from 1 day to 15 years (mean age : 109 months). Two patients (6.8%) were younger than 1, two (6.8%) younger than 4, 10 (34.5%) between 4 and 10, and 15 (51.9%) older than 10 years. Nineteen patients (65.5%) were male. The most common cause was traffic accident (14 cases, 48.2%). In cases of traffic accident, pedestrian hit was most com- mon cause (9 cases, 31%) followed by fall down (6 cases, 20.6%), slip down (6 cases, 20.6%), and birth injury (1 case, 3.4%) (Fig. 1). One case was due to unknown cause. He had no history of trauma. The GCS score before hematoma evacuation ranged from 3 to 15 (Mean score, 12.9). Only 1 patient (3.4%) had se- vere head injury (GCS score <8), 6 patients (20.7%) had a GCS score between 9 and 12, and in 22 patients (75.9%), the GCS score was 13 to 15. The mean time to surgery was 23 hours; however, 11 patients (37.9%) underwent surgical evacuation of the hematoma within 10 hours. Delayed surgery (more than 10 hours after trauma) was performed in 8 cases (27.5%). Abnor- mal pupil finding was only 2 cases (6.8%) (Table 1). Surgical procedures and imaging studies All patients were treated according to a standard advanced Radiologic finding Hematoma location was temporal in 13 cases (44.8%), frontal 216