Spine and Spinal Disorders

Biography

Biography: Lalithambigai Gannison

Abstract

Purpose : Extradural hematoma (EDH), a common sequelae of traumatic brain injury, can lead to mortality and disability if a delay in identifying the pathology and subsequent management. In 1920s, mortality rates were reported as 86% and improved to 10% over the new millennium. We review our EDH cases to identify how we can achieve zero mortality, the ultimate goal of management for EDH. Materials and Methods: We retrospectively reviewed all traumatic EDH cases seen in the specialised paediatric neurosurgery department of Sabah Women & Children Hospital from the period of January 2013 to August 2018. Patient’s case records, operative notes and radiological images were traced and reviewed. A total of 101 cases were identified. Results :We had 101 patients ranging from ages of 9 months to 12 years. Out of it, 58 patients (58.41%) were males and 42 were females (41.59%). A total of 37 patients (36.3%) were treated surgically and 64 patients (63.7%) were treated conservatively. About 92 patients (91.09%) presented with supratentorial EDH and 9 patients (8.91%) had infratentorial EDH. Skull fractures were present in 47 children (46.5%). In the paediatric age group, fall from heights were the commonest cause. We achieved zero mortality among our patients who were treated both surgically and conservatively. Conclusion : EDH, a neurotrauma emergency, can be lethal yet the most rewardingly responsive lesions treated by neurosurgeons. Early diagnosis, prompt referrals, early surgical intervention when indicated and good intensive care remain the paramount facets towards achieving zero mortality in EDH. This study proves that our results are comparable to those seen in other neurosurgical centres throughout the developed world. An institutional protocol for EDH may ensure that the ultimate goal of towards ‘zero mortality’ could be achieved systematically and consistently.