Most of the hematoma epidural is a surgical emergency and must be evacuate as soon as possible. Because brain hematoma epidural under generally quite normal, every effort made to reduce the pressure as soon as possible to prevent brain damage. Outcome of surgery for the hematoma epidural is very dependent on the patient's clinical condition prior to evacuation operative. When clot large, or there is doubt on the extent of brain damage underneath, it is recommended to make craniotomy flap wide standard. In the case where the hematoma epidural clearly limited to one Regio and where there is not accompanied by subdural bleeding on the CT scan appears, flap craniotomi a small modification can be used (Saanin, 2007).
HED with volume of 30 ml, 15 mm thickness and require surgical evacuation action because almost most of the patients with the HED of this kind shows that the level of awareness and poor showing signs - signs lateralisasi (Ullman, 2006).
Location is also an important factor in determining the operative. Hematoma in the Temporal, if the size or spread, can cause herniasi and cause disorients more quickly. HED in the posterior fossa, which is sometimes associated with the dissolution lateral sinus venosus, which requires surgery take action - the heart because the available space is very limited (Ullman, 2006).
In the period before the CT scan, the exploration drill often do, especially if the patient has shown symptoms lateralisasi or deorientasi quickly. Now, with a fast scanning techniques, such as how this is rarely done (Ullman, 2006).
Some circumstances be indicative actions Explore the drill hole (Price, 2006):
intrakranial Hypertension instability with a heavy hemodinamik
Alerts - sign herniasi start to appear
Not available nerve surgeon for immediate consultation
Trepanasi (or laying of the drill) should be done after consultation with the surgeon nerve, if possible, after residing in the central health.
land or air transport is too long
Procedure in taking action to make the drill hole according to Price (2006) include:
Make a deep hole, but not exceed, the broken bones in the skull or from the area indicated CT scan.
If no CT scan, wimble placed on the side where the pupil is more dilatasi, 2 fingers to the anterior to the ear tragus and 3 finger over it.
In research conducted by Liu, et al in 2006, explained that with the evacuation drill holes and drainage with negative pressure is safe and effective for handling emergency the HED because trauma.
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