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Surgical management of acute epidural hematomas.

Neurosurgery 2006 March
INDICATIONS FOR SURGERY: An epidural hematoma (EDH) greater than 30 cm3 should be surgically evacuated regardless of the patient's Glasgow Coma Scale (GCS) score. An EDH less than 30 cm3 and with less than a 15-mm thickness and with less than a 5-mm midline shift (MLS) in patients with a GCS score greater than 8 without focal deficit can be managed nonoperatively with serial computed tomographic (CT) scanning and close neurological observation in a neurosurgical center.

TIMING: It is strongly recommended that patients with an acute EDH in coma (GCS score < 9) with anisocoria undergo surgical evacuation as soon as possible.

METHODS: There are insufficient data to support one surgical treatment method. However, craniotomy provides a more complete evacuation of the hematoma.

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