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Year : 2018  |  Volume : 13  |  Issue : 2  |  Page : 375-379

Disappearance of intracranial extradural hematomas: Role of diastatic cranial fracture and intracranial pressure - An institutional experience

Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

Correspondence Address:
Abdul Rashid Bhat
Department of Neurosurgery, Sher-i-kashmir Institute of Medical Sciences, Srinagar - 190 011, Jammu and Kashmir
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1793-5482.228577

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Context: The intracranial extradural hematoma (EDH) occupies space and creates a mass effect on the brain but the tenacious-adhesions of dura to the inner table of skull counters this effect. The intracranial pressure also pushes the hematoma back while it is held by dural tensile-force. Aims: The exploitation of a diastatic fracture, overlying an EDH, by the intracranial pressures to decompress a hematoma out of extradural space into subgaleal/subperiosteal space without surgical intervention. Settings and Design: In a period of 15 years, a group of 11 patients among 729 EDHs were managed conservatively. Materials and Methods: The retrospective study of 11 EDH patients was conducted in the Department of Neurosurgery from January 2000 to December 2014 in 15 years. Statistical Analysis Used: The statistical law of variance was used as applicable. Results: Analysis of spontaneous disappearance of intracranial EDH among 11 patients revealed that only 1.5% (11/729) EDHs resolved conservatively. The most cases (63.6%) were children and the youngest being 9 months old. All the patients had a diastatic fracture overlying-EDH and were fully conscious. The cause of head injury in most was the fall from height. The hospital stay ranged from 2 to 4 days. All the patients had a good recovery at the time of discharging. Conclusion: The trial of the conservative or spontaneous disappearance of an EDH through a diastatic fracture into the subgaleal space is similar to burr-hole drainage without surgical intervention but depends upon the neurological status, the intracranial pressure of the patient, and the availability of all the modern neurosurgical gadgets.

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