Managing Acute Epidural Hematoma with Volume Less Than 30 cm³ and GCS Greater Than 8 Without Focal Neurological Deficit

Not every epidural hematoma requires emergency surgery. When CT findings and neurological status fall within specific boundaries, a carefully monitored nonoperative approach may be appropriate — governed by strict criteria and mandatory surveillance.

Clinical Scenario Acute epidural hematoma with volume under 30 cm³, thickness under 15 mm, and midline shift under 5 mm on CT — in a patient with a Glasgow Coma Scale score greater than 8 and no focal neurological deficit.

Approach Overview

This scenario may be candidates for nonoperative management, avoiding immediate surgery. The protocol centres on serial CT imaging and close neurological observation carried out within a neurosurgical centre — with defined timing for the first follow-up scan.

The complete protocol — including full observation parameters, escalation thresholds, and all clinical decision criteria — is available below.

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References

DOI: 10.1227/01.NEU.0000210363.91172.A8

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.

The first follow-up CT scan in nonoperative patients should be obtained within 6 to 8 hours after TBI.

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