Surgical exploration before computed tomography scanning in children with traumatic tentorial herniation

Brian T. Andrews, Amy M. Ross, Lawrence H. Pitts

    Research output: Contribution to journalArticle

    3 Scopus citations

    Abstract

    Seventeen consecutive children with early clinical signs of tentorial herniation after head injury underwent immediate burr-hole exploration before computed tomography scanning. In nine children (53%), a subdural hematoma was discovered and immediately evacuated. In one, a small intracerebral hemorrhage was diagnosed by intraoperative ultrasonography. Postoperative studies showed that no intraaxial or extraaxial hematoma was missed by surgical exploration. Nine children (53%) survived; eight (47%) died. The survival rate was higher among patients with a mass lesion than among those without. Seven children had a good recovery, and two were moderately disabled (mean follow-up, 15.2 months). We conclude that a significant proportion of head-injured children with clinical signs of tentorial herniation have extraaxial hematomas that can be readily identified and evacuated by immediate surgical exploration. The survival rate and extent of recovery in children appear to be better than in similarly injured adults.

    Original languageEnglish (US)
    Pages (from-to)434-438
    Number of pages5
    JournalSurgical Neurology
    Volume32
    Issue number6
    DOIs
    StatePublished - Dec 1989

    Keywords

    • Burr-hole exploration
    • Head injury
    • Hematoma
    • Tentorial herniation

    ASJC Scopus subject areas

    • Surgery
    • Clinical Neurology

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