Tratamento conservador dos hematomas extradurais laminares na infância

Ciquini Júnior, Orildo; Santos, Alberto L. Moura dos; Manreza, Luiz A.; Plese, J. Píndaro P.; Marino Júnior, Raul

doi:10.1590/S0004-282X1992000400014

Resumos

Os autores relatam sua experiência com o tratamento conservador de 15 crianças com hematoma extradural (HED) laminar traumático. Todas, por ocasião do diagnóstico, apresentavam-se neurologicamente estáveis e sem sinais de herniação intracraniana. Estes HED foram descobertos em períodos de 30 minutos e 5 dias depois do trauma, a maioria estando localizados na região parietal. OHED foi reabsorvido espontaneamente em todos os casos, num período que variou de 2 a 12 dias. Os critérios para seleção destes pacientes e os cuidados com essa modalidade de tratamento do HED são discutidos.

hematoma extradural em crianças; tratamento conservador; tomografia computadorizada

We sucessfully treated by nonsurgical methods 15 children with laminar epidural hematomas (EH), with minimal neurological symptoms and no signs of brain herniation. These EH were discovered 30 minutes to 5 days after head injury. The majority were localized in the parietal region. All children recovered without surgery from 2 to 12 days after hospitalization and all had evidence on CT scan of spontaneous clot reabsortion. We discuss the criteria for patient selection for this kind of treatment on EH in children.

extradural hematoma in children; conservative management; computerized tomography

Orildo Ciquini Júnior^I; Alberto L. Moura dos Santos^II; Luiz A. Manreza^III; J. Píndaro P. Plese^IV; Raul Marino Júnior^V

^INeurocirurgião. Estudo realizado na Disciplina de Neurocirurgia do Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IIResidente de Neurocirurgia. Estudo realizado na Disciplina de Neurocirurgia do Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IIIProfessor Assistente. Estudo realizado na Disciplina de Neurocirurgia do Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IVProfessor Associado. Estudo realizado na Disciplina de Neurocirurgia do Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^VProfessor Titular. Estudo realizado na Disciplina de Neurocirurgia do Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

RESUMO

Os autores relatam sua experiência com o tratamento conservador de 15 crianças com hematoma extradural (HED) laminar traumático. Todas, por ocasião do diagnóstico, apresentavam-se neurologicamente estáveis e sem sinais de herniação intracraniana. Estes HED foram descobertos em períodos de 30 minutos e 5 dias depois do trauma, a maioria estando localizados na região parietal. OHED foi reabsorvido espontaneamente em todos os casos, num período que variou de 2 a 12 dias. Os critérios para seleção destes pacientes e os cuidados com essa modalidade de tratamento do HED são discutidos.

Palavras-chave: hematoma extradural em crianças, tratamento conservador, tomografia computadorizada.

SUMMARY

We sucessfully treated by nonsurgical methods 15 children with laminar epidural hematomas (EH), with minimal neurological symptoms and no signs of brain herniation. These EH were discovered 30 minutes to 5 days after head injury. The majority were localized in the parietal region. All children recovered without surgery from 2 to 12 days after hospitalization and all had evidence on CT scan of spontaneous clot reabsortion. We discuss the criteria for patient selection for this kind of treatment on EH in children.

Key words: extradural hematoma in children, conservative management, computerized tomography.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. José Píndaro Pereira Plese Clínica Neurológica, Hospital das Clinicas, FMUSP - Caixa Postal 8091 - 01065 São Paulo SP - Brasil.

1. Ammirati M, Tomita T. Epidural hematomas in infancy and childhood. Riv Neurose Ped (J Ped Neurose) 1985, 1:123-128.
2. Bullock R, Smith RM, VanDellen J. Nonoperative management of extradural hematoma. Neurosurgery 1985, 16:602-606.
3. Choux M, Liena G, Genitore L, Empieme E, Dechambendis G. Pediatric head injuries. In Braákman R (eds): Handbook of Clinical Neurology, Vol 13(57), Head Injury. Amsterdam: Elsevier, 1990, p 327-343.
4. Ericson K, Hanansson S. Computed tomography of epidural hematomas: association with intracranial lesions and clinical correlation. Acta Radiol 1981, 22:513-519.
5. Frankhauser H, Uske A, de TTibolet N. Delayed epidural hematoma: a propos of a serie of 8 cases. Neurochirurgie 1983, 29:255-260.
6. Gennarelli TA, Spilman GM, Langfih TW, Gildenberg PL/, Harington T, Jane JA, Marshall KF, Miller JD, Pitts LH. Influence of the type of intracranial lesion on outcome from severe head injury: a multicenter study using a new classification system. J Neu-rosurg 1982, 56:26-32.
7. Illingworth R, Schawdow H. Conservative management of intracranial extradural hae-matomas presenting late. J Neurol Neurosurg Psychiatry 1983, 46:558-560.
8. Knuckey NW, Gelbard S, Epstein MH. The management of asymptomatic epidural hematomas. J Neurosurg 1989, 70:392-396.
9. McLaurin RL, Towbin RB. Post-traumatic hematomas. In McLaurin RL, Schult L, Veres JL, Epstein F (eds): Pediatric Neurosurgery Ed 2. Philadelphia: Saunders, 1989, 277-289.
10. Mendelow AD, Karmini Z, Paul KS. Extradural haematoma effect of delayed treatment. Br Med J 1979, 1:1240-1242.
11. Negishi H, Lee Y, Ioth K, Suzuki J, Nishino M, Takada S, Yamasaki S. Monsurgical management of epidural hematoma in neonates. Pediatr Neurol 1989, 5:253-256.
12. Pang D, Horton JA, Herron JM, Wilberg SE, Vries JK. Nonsurgical management of extradural hematomas in children. J Neurosurg 1983, 59:958-971.
13. Pozzati E, Tognetti F. Spontaneous healing of acute extradural hematomas: study of twenty-two cases. Neurosurgery 1986, 18:696-700.
14. Sakai H, Taragi H, Ohtaka H. Serial changes in acute extradural hematoma size and associated changes in level of consciousness and intracranial pressure. J Neurosurgery 1988, 68:566-570.
15. Smith HK, Miller JD. The danger of an ultra-early computed tomographic scan in a patient with an evolving acute epidural hematoma. Neurosurgery 1991, 29:258-260.
16 Weaver D, Pobereskin L, Jane JA. Spontaneous resolution of epidural hematomas: report of two cases. J Neurosurg 1981, 54:248-251.

Tratamento conservador dos hematomas extradurais laminares na infância

Nonsurgical management of laminar extradural hematomas in children

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Dez 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ammirati M, Tomita T. Epidural hematomas in infancy and childhood. Riv Neurose Ped (J Ped Neurose) 1985, 1:123-128.

[2] 2. Bullock R, Smith RM, VanDellen J. Nonoperative management of extradural hematoma. Neurosurgery 1985, 16:602-606.

[3] 3. Choux M, Liena G, Genitore L, Empieme E, Dechambendis G. Pediatric head injuries. In Braákman R (eds): Handbook of Clinical Neurology, Vol 13(57), Head Injury. Amsterdam: Elsevier, 1990, p 327-343.

[4] 4. Ericson K, Hanansson S. Computed tomography of epidural hematomas: association with intracranial lesions and clinical correlation. Acta Radiol 1981, 22:513-519.

[5] 5. Frankhauser H, Uske A, de TTibolet N. Delayed epidural hematoma: a propos of a serie of 8 cases. Neurochirurgie 1983, 29:255-260.

[6] 6. Gennarelli TA, Spilman GM, Langfih TW, Gildenberg PL/, Harington T, Jane JA, Marshall KF, Miller JD, Pitts LH. Influence of the type of intracranial lesion on outcome from severe head injury: a multicenter study using a new classification system. J Neu-rosurg 1982, 56:26-32.

[7] 7. Illingworth R, Schawdow H. Conservative management of intracranial extradural hae-matomas presenting late. J Neurol Neurosurg Psychiatry 1983, 46:558-560.

[8] 8. Knuckey NW, Gelbard S, Epstein MH. The management of asymptomatic epidural hematomas. J Neurosurg 1989, 70:392-396.

[9] 9. McLaurin RL, Towbin RB. Post-traumatic hematomas. In McLaurin RL, Schult L, Veres JL, Epstein F (eds): Pediatric Neurosurgery Ed 2. Philadelphia: Saunders, 1989, 277-289.

[10] 10. Mendelow AD, Karmini Z, Paul KS. Extradural haematoma effect of delayed treatment. Br Med J 1979, 1:1240-1242.

[11] 11. Negishi H, Lee Y, Ioth K, Suzuki J, Nishino M, Takada S, Yamasaki S. Monsurgical management of epidural hematoma in neonates. Pediatr Neurol 1989, 5:253-256.

[12] 12. Pang D, Horton JA, Herron JM, Wilberg SE, Vries JK. Nonsurgical management of extradural hematomas in children. J Neurosurg 1983, 59:958-971.

[13] 13. Pozzati E, Tognetti F. Spontaneous healing of acute extradural hematomas: study of twenty-two cases. Neurosurgery 1986, 18:696-700.

[14] 14. Sakai H, Taragi H, Ohtaka H. Serial changes in acute extradural hematoma size and associated changes in level of consciousness and intracranial pressure. J Neurosurgery 1988, 68:566-570.

[15] 15. Smith HK, Miller JD. The danger of an ultra-early computed tomographic scan in a patient with an evolving acute epidural hematoma. Neurosurgery 1991, 29:258-260.

[16] 16 Weaver D, Pobereskin L, Jane JA. Spontaneous resolution of epidural hematomas: report of two cases. J Neurosurg 1981, 54:248-251.