Bullock M Ross, Chesnut Randall, Ghajar Jamshid, Gordon David, Hartl Roger, Newell David W, Servadei Franco, Walters Beverly C, Wilberger Jack E
Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Neurosurgery. 2006 Mar;58(3 Suppl):S7-15; discussion Si-iv.
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.
It is strongly recommended that patients with an acute EDH in coma (GCS score < 9) with anisocoria undergo surgical evacuation as soon as possible.
There are insufficient data to support one surgical treatment method. However, craniotomy provides a more complete evacuation of the hematoma.
硬膜外血肿（EDH）体积大于30 cm³，无论患者的格拉斯哥昏迷量表（GCS）评分如何，均应进行手术清除血肿。对于GCS评分大于8且无局灶性神经功能缺损的患者，若EDH体积小于30 cm³、厚度小于15 mm且中线移位（MLS）小于5 mm，可在神经外科中心通过连续计算机断层扫描（CT）及密切神经学观察进行非手术治疗。
强烈建议急性昏迷（GCS评分<9）且伴有瞳孔不等大的硬膜外血肿患者尽快接受手术清除血肿。
目前尚无足够数据支持某一种手术治疗方法。然而，开颅手术能更彻底地清除血肿。
