Role of routine post-operative CT brain following evacuation of extradural haematoma in children: a single-centre experi
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ORIGINAL ARTICLE
Role of routine post-operative CT brain following evacuation of extradural haematoma in children: a single-centre experience Michael Amoo 1,2
&
Roisin M. O’Cearbhaill 3 & John Caird 1,2 & Sarah Power 3 & Darach Crimmins 1,2
Received: 19 April 2020 / Accepted: 5 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Extradural haematoma (EDH) is a serious neurosurgical emergency in children, which confers significant morbidity and mortality rates. The objective of this study was to retrospectively evaluate the role of post-operative imaging in children with EDH who were managed surgically in a national paediatric neurosurgical unit over a 9-year period (January 2008 to December 2016). Methods A retrospective case review of paediatric patients who underwent surgical evacuation of extradural haematoma between January 2008 and December 2016 was performed. This included demographic and clinical details, indications for postoperative imaging and outcomes. Results Seventy patients underwent surgical management of EDH during this time period, with a male preponderance (69%) and a mean age of 8 years. The commonest location of haematoma in this cohort was in the parietal region (n = 24), with a mean maximum thickness of 25.9 mm and mean volume of 57 ml. Post-operative imaging was performed in 84% of patients. However, only one patient had a change in the course of their post-operative management as a result of post-operative imaging findings. Conclusions Post-operative imaging in asymptomatic paediatric patients after evacuation of EDH could therefore be avoided as a routine investigation. Keywords Extradural haematoma . Post-operative imaging . Traumatic brain injury . Paediatric neurosurgery
Introduction Extradural haematoma (EDH) is a neurosurgical emergency caused by the traumatic accumulation of blood between the inner table of the skull and the dural meningeal layer. The management options include surgical or conservative management. Current guidelines advocate for surgical management in patients with EDH volume > 30 ml or > 15 mm thickness, > 5 mm midline shift or presence of anisocoria in moderate to severe TBI [2]. Computed tomography (CT) is the primary imaging modality used in diagnosis and evaluation. However, the role of
* Michael Amoo [email protected] 1
Department of Paediatric Neurosurgery, Temple Street Children’s University Hospital, Dublin, Ireland
2
Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland
3
Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
imaging in the post-operative setting is unclear. There are currently no guidelines regarding post-operative imaging; this decision is usually made on an individual basis. A number of studies which investigated the role of serial imaging in paediatric patients with EDH, managed conservatively, found that serial imaging had little influence on management in patients who remain clinically stable [3, 6, 7, 10]. However, no study has directly evaluated the role of imaging i
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