Frontal Epidural Haematoma: Analysis Of 30 Cases

摘要

Background: The epidural haematoma is the most important expanding lesion due to head injury with high indexes of mortality and morbidity when the correct management is not done. Frontal epidural haematoma is considered rare, representing about 10% of the whole epidural haematoma. They are usually unilateral and may present with subacute and chronic evolution in 40% of the cases. Objective: To study thirty cases of frontal epidural haematoma and analyze the causes, clinical findings, evolution, and outcome. Patients and Methods: We studied 30 patients, retrospectively, with frontal epidural haematoma. Twenty-four cases were male and six female. The age ranged from 10-32 years old, with a mean of 18 years old. Results: The main causes were traffic accidents and falls. In three cases the haematoma was bilateral. Acute collection occurred in 19 cases, subacute in 05 and chronic in 06. The most important clinical findings were headaches, vomiting and seizures. Skull x-rays detected fracture in 18 cases and computed tomography was positive in demonstrating the haematoma. Surgery was carried out in 28 patients and two cases had conservative treatment. Two patients died in consequence of associated intracerebral and extracerebral lesions. Conclusions: 1) the frontal epidural haematoma is more frequent in young adults; 2) its evolution is slow, usually subacute or chronic, in majority of the cases; 3) the clinical findings of the frontal epidural haematoma course with few neurological symptoms during its evolution and 4) the prognosis is good, except those cases with multiples lesions or systemic injury. Introduction Epidural haematomas generally have an acute onset and are located in the temporoparietal area.16The main cause of the epidural haematomas is the head injury and the young adults have more risk to this lesion. However, other causes were described to explain the epidural pathology.10In Brazil, about 500.000 persons died per year due to traffic accident and its considered by the Brazilian government a public health question. Much money is dispending to treat these patients and few advances were done.Nowadays, the best exam to diagnostic the epidural haematoma is the computed tomography (CT). In the era before CT, the mortality due to epidural haematoma was 40-80%, and after CT, the mortality is about 10%.9 The CT scan is appropriated to trauma because is an exam relatively fast with high accuracy. Therefore, the first case of conservative treatment was described by Weaver et al 20in the CT era. These authors refer that the CT scan created a new group of patients: the patients with epidural haematoma and no symptoms. Pang et al 15described the evolution of the epidural haematoma by CT and divided it in two groups: type A and type B. Much advances were obtained with CT.A specific frontal epidural haematoma (FEH) type has been observed in 10% of the cases, and there are few papers about it.4,8,12FEH may present with subacute or chronic evolution in one third of the cases and few neurological symptoms are found with good outcome.The aim of this study is to report thirty cases of FEH and to discuss the evolution, neurologic presentation, treatment and outcome. Material and Methods We studied, retrospectively, during 2001-2004, 30 patients with FEH by the Department of Neurosurgery of the Jo?o Alves Filho Hospital (Aracaju-Sergipe-Brazil) and by the Department of Neurosurgery of the Santa Lucia Clinic (Rio de Janeiro-Rio de Janeiro-Brazil). This study was approved by the Ethical Committee of each Hospital. The patients were study according to sex, age, etiology of the FEH, clinical findings, treatment and outcome. The Glasgow Coma Score was obtained from all patients at admission. The outcome was gauged by the Glasgow Outcome Scale (GOS)2: 1) good recovery; 2) moderate disability; 3) severe disability; 4) persistent vegetative state; 5) death. The patients with one or two points in GOS were considered excellent outcome. The criter