Context: The intracranial extradural hematoma (EDH) occupies space and creates a mass effect
on the brain but the tenacious-adhesions of dura to the inner table of skull counters
this effect. The intracranial pressure also pushes the hematoma back while it is held
by dural tensile-force. Aims: The exploitation of a diastatic fracture, overlying an EDH, by the intracranial pressures
to decompress a hematoma out of extradural space into subgaleal/subperiosteal space
without surgical intervention. Settings and Design: In a period of 15 years, a group of 11 patients among 729 EDHs were managed conservatively.
Materials and Methods: The retrospective study of 11 EDH patients was conducted in the Department of Neurosurgery
from January 2000 to December 2014 in 15 years. Statistical Analysis Used: The statistical
law of variance was used as applicable. Results: Analysis of spontaneous disappearance of intracranial EDH among 11 patients revealed
that only 1.5% (11/729) EDHs resolved conservatively. The most cases (63.6%) were
children and the youngest being 9 months old. All the patients had a diastatic fracture
overlying-EDH and were fully conscious. The cause of head injury in most was the fall
from height. The hospital stay ranged from 2 to 4 days. All the patients had a good
recovery at the time of discharging. Conclusion: The trial of the conservative or spontaneous disappearance of an EDH through a diastatic
fracture into the subgaleal space is similar to burr-hole drainage without surgical
intervention but depends upon the neurological status, the intracranial pressure of
the patient, and the availability of all the modern neurosurgical gadgets.
Key-words:
Intracranial extradural hematoma - intracranial pressures - skull fracture - spontaneous
decompression
