Clinical, operative, and outcome analysis of giant extradural hematoma: A retrospective study in tertiary care center

Background This study is aimed to find a critical volume of operated giant or massive extradural hematoma (EDH) that affects outcome significantly and analyze them with respect to their clinical, surgical, and outcome perspective. Methods This retrospective study includes 253 patients operated for EDH in emergency in the Department of Neurosurgery of IMS BHU, Varanasi, India, a tertiary care center, between August 1, 2018, and November 1, 2019. Giant EDH critical volume was evaluated. Twenty-nine patients with giant EDH with clot volume ≥ 80 ml were further analyzed for clinical, surgical, and outcome predictive factors. Statistical analysis was done using Prism GraphPad ver. 8.0.0. P value was taken at 0.05. Results Dichotomized group analysis with Glasgow Outcome Score (GOS) 4-5 versus GOS 1-3 for testing clot volume revealed significance difference with P 80 ml for further analysis. The most common age group was 20-40 (55.17%). M2 (31.03%) was the most common best motor response in operated giant EDH cases. Most of them were having severe (79.31%) head injury. Glasgow Coma Scale (GCS) at admission (P < 0.0001), pupillary changes (P = 0.0032), and best motor response (P < 0.0001) was significantly (P < 0.05) associated with outcome following surgery for giant EDH. Conclusion Giant EDH with volume ≥ 80 ml is associated with poorer outcome. GCS at admission, pupillary changes, and best motor response is predictors for surgical outcome of giant EDH.