Marhold Franz, Prihoda Romana, Pruckner Philip, Eder Vanessa, Glechner Anna, Klerings Irma, Gombos Jozsef, Popadic Branko, Antoni Anna, Sherif Camillo, Scheichel Florian
Karl Landsteiner University of Health Sciences, Krems, Austria.
Division of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria.
Front Surg. 2023 Aug 1;10:1188861. doi: 10.3389/fsurg.2023.1188861. eCollection 2023.
Epidural hematomas (EDH) occur in up to 8.2% of all traumatic brain injury patients, with more than half needing surgical treatment. In most patients suffering from this perilous disease, good recovery with an excellent clinical course is possible. However, the clinical course is mainly dependent on the presence of additional intracerebral injuries. Few studies comparing isolated and combined EDH in detail exist.
We performed a retrospective single-center study from April 2002 to December 2014. The mean follow-up time was more than 6 years. In addition to analyzing diverse clinicoradiological data, we performed a systematic literature review dealing with a detailed comparison of patients with (combined) and without (isolated) additional intracerebral injuries.
We included 72 patients in the study. With increasing age, combined EDH had a higher incidence than isolated EDH. The mortality rate of the patients in the cohort was 10%, of which 0% had isolated EDH and 10% had combined EDH. Good recovery was achieved in 69% of patients, of which 91% had isolated EDH and 50% had combined EDH. A subgroup analysis of the different additional intracerebral injuries in combined EDH demonstrated no significant difference in outcome. A systematic literature review only identified six studies. Patients with isolated EDH had a statistically significantly lower mortality risk [relative risk (RR): 0.22; 95% CI: 0.12-0.39] and a statistically significantly lower risk of unfavorable Glasgow outcome scale score (RR: 0.21; 95% CI: 0.14-0.31) than patients with combined EDH.
An excellent outcome in patients with surgically treated isolated EDH is possible. Furthermore, patients with combined EDH or isolated EDH with a low Glasgow coma scale (GCS) score may have favorable outcomes in 50% of the cases. Therefore, every possible effort for treatment should be made for this potentially lethal injury.
硬膜外血肿（EDH）在所有创伤性脑损伤患者中的发生率高达8.2%，超过半数患者需要手术治疗。大多数患有这种危险疾病的患者有可能实现良好恢复并拥有出色的临床病程。然而，临床病程主要取决于是否存在其他脑内损伤。很少有研究对孤立性和合并性硬膜外血肿进行详细比较。
我们进行了一项回顾性单中心研究，时间跨度为2002年4月至2014年12月。平均随访时间超过6年。除了分析各种临床放射学数据外，我们还进行了一项系统的文献综述，详细比较了有（合并性）和无（孤立性）其他脑内损伤的患者。
我们纳入了72例患者进行研究。随着年龄增长，合并性硬膜外血肿的发生率高于孤立性硬膜外血肿。该队列患者的死亡率为10%，其中孤立性硬膜外血肿患者的死亡率为0%，合并性硬膜外血肿患者的死亡率为10%。69%的患者实现了良好恢复，其中孤立性硬膜外血肿患者中有91%实现了良好恢复，合并性硬膜外血肿患者中有50%实现了良好恢复。对合并性硬膜外血肿中不同的其他脑内损伤进行亚组分析，结果显示预后无显著差异。一项系统的文献综述仅检索到六项研究。与合并性硬膜外血肿患者相比，孤立性硬膜外血肿患者的死亡风险在统计学上显著更低[相对风险（RR）：0.22；95%置信区间（CI）：0.12 - 0.39]，格拉斯哥预后量表评分不良的风险在统计学上也显著更低（RR：0.21；95%CI：0.14 - 0.31）。
接受手术治疗的孤立性硬膜外血肿患者有可能获得出色的预后。此外，合并性硬膜外血肿或格拉斯哥昏迷量表（GCS）评分低的孤立性硬膜外血肿患者在50%的病例中可能有良好的预后。因此，对于这种潜在致命性损伤应尽一切可能进行治疗。
