What is the mortality rate of acute epidural hematoma

In the treatment of acute epidural hematoma, in principle, surgery should be performed as soon as it is diagnosed. The hematoma should be ruled out to relieve intracranial hypertension. After surgery, appropriate non-surgical treatment should be given according to the condition. Generally, if there are no other serious complications and the primary brain damage is mild, the prognosis is good. The mortality rate is between 10% and 25%, and there is a large disparity in different regions or units. In fact, the main cause of death of such patients is not the hematoma itself, but the secondary damage to the brain stem caused by the formation of the brain herniation. Therefore, early diagnosis and timely treatment must be made to effectively reduce the mortality rate.

1) Surgical treatment: usually bone window craniotomy or bone flap craniotomy is used to facilitate complete removal of hematoma, adequate hemostasis, and subdural exploration if necessary. It is a long-standing operation for epidural hematoma. In recent years, due to the wide application of CT scans, the location, size and brain damage of the hematoma are well known, and the changes of the hematoma can be dynamically observed. Therefore, some authors have also succeeded in using a skull drill to drain the epidural hematoma. ①Bone window craniotomy for epidural hematoma removal: it is suitable for patients who are in critical condition and have a brain herniation that is too late for imaging diagnosis and positioning, and are directly sent to the operating room for rescue. First, drill and explore, and then expand the osteogenesis window to remove the hematoma . The order of drilling should be near the temporal fracture line on the side with dilated pupils. About 60% to 70% of epidural hematomas can be found. After detecting the hematoma, extend the incision as needed, expand the bone puncture, drain the hematoma, and properly stop the bleeding. If the dural tension is still high after the hematoma is removed, or when it is swollen or blue, it should be incised and explored to avoid missing the subdural or intracerebral hematoma. After the operation, a rubber drainage strip was placed on the epidural, and the scalp was sutured in layers. The skull defect is reserved for selective repair after 2 to 3 months. ②Bone flap craniotomy for epidural hematoma removal: it is suitable for cases where the hematoma is clearly located. According to the results of imaging examinations, craniotomy was performed with bone flaps. After exposing the hematoma, there is no need to rush to excavate the hemorrhage. Therefore, the intracranial pressure has been considerably relieved. In order to reduce the bleeding, the hematoma can be peeled off gradually from the periphery of the hematoma to the thickest part of the hematoma near the base of the skull. Most of the ruptured dural arteries and veins can be found , And to be electrocoagulated or stitched. After the hematoma is cleared, it is advisable to wash the wound with normal saline, carefully examine whether there are bleeding points, and stop them one by one to prevent re-bleeding after surgery. If the dural tension is high or there is a suspected subdural hematoma, the dura should be opened and explored. Do not simply remove the bone flap to decompress and end the operation hastily. It should be noted that omission of hematoma is one of the important causes of postoperative death of patients. After the operation, the dura mater was suspended on the outer edge of the bone window, the bone flap was also inserted, the scalp was sutured in layers, and the dura mater was drained for 24 to 48 hours. ③Drilling and puncture to remove epidural hematoma: It is suitable for emergency rescue of particularly acute epidural hematoma. In order to temporarily relieve intracranial hypertension and gain time, tap or drill first to discharge part of liquid hematoma. This emergency measure has been used for pre-hospital first aid or drainage of intracerebral hematoma. Recently, some scholars have used the treatment of acute epidural hematoma to quickly drain the hematoma to rescue patients. The indication is that the condition is relatively stable, the bleeding volume is about 30-50ml, the location is clearly determined by CT examination, the midline is displaced by more than 0.5cm, and there is no continued bleeding. The method is to use a taper or drill hole according to the thickest part of the hematoma as shown by CT, and then insert a suction needle tube or insert a shredded suction needle tube with a thinner wire. After draining part of the blood, inject urokinase, or urokinase plus hyaluronidase to dissolve the remaining blood clot, repeat it several times, and keep the tube for 3-6 days until the CT recheck hematoma is exhausted.

2) Non-surgical treatment: no matter whether the acute epidural hematoma is operated or not, timely and reasonable non-surgical treatment is required, especially for patients with severe primary brain injury and/or secondary brain damage. Can't be taken lightly.

Conservative treatment of epidural hematoma: suitable for conscientious and balanced disease; CT examination of the hematoma measurement is less than 40ml, and the midline shift does not exceed 1.5cm; unconscious deterioration, fundus edema and new symptoms appear; non-middle or posterior fossa hematoma By. The treatment measures should be based on the premise of closely observing the clinical manifestations of the patient, using dehydration, hormones, hemostasis and blood stasis treatment drugs, such as Danshen, Chuanxiong, etc., and the use of CT for dynamic monitoring to ensure safety.

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