Tratamiento no quirúrgico de los hematomas epidurales y subdurales de pequeño y mediano tamaño. Criterios para la selección y seguimiento de los pacientes
R.D. Lobato, F. Servadei, P.A. Gómez, P. González
Servicio de Neurocirugía, Hospital «12 de Octubre», Facultad de Medicina, Universidad Complutense, Madrid, y División of Neurosurgery, Ospedale Maurizio Bufalini, Cesena Italia
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Pimentel" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Pimentel" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147397710510?idApp=UINPBA00004B" "url" => "/11301473/0000000800000001/v1_201305151458/S1130147397710510/v1_201305151458/es/main.assets" ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Tratamiento no quirúrgico de los hematomas epidurales y subdurales de pequeño y mediano tamaño. Criterios para la selección y seguimiento de los pacientes" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "16" "paginaFinal" => "24" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "R.D. Lobato, F. Servadei, P.A. Gómez, P. González" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R.D." "apellidos" => "Lobato" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Servadei" ] 2 => array:2 [ "nombre" => "P.A." "apellidos" => "Gómez" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "González" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurocirugía, Hospital «12 de Octubre», Facultad de Medicina, Universidad Complutense, Madrid, y División of Neurosurgery, Ospedale Maurizio Bufalini, Cesena Italia" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec163065" "palabras" => array:3 [ 0 => "Hematoma epidural" 1 => "Hematoma subdural" 2 => "Tomografía computerizada" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec163064" "palabras" => array:3 [ 0 => "Epidural hematoma" 1 => "Subdural hematoma" 2 => "Computerized tomography" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tradicionalmente el diagnóstico de un hematoma extracerebral postraumático iba seguido de su evacuación inmediata. Sin embargo, en la actualidad un número considerable de pacientes con este tipo de hematoma que están asintomáticos, o muestran síntomas mínimos, son tratados satisfactoriamente sin necesidad de cirugía. El problema clínico en relación con el posible tratamiento conservador de estos hematomas es importante ya que el uso rutinario de la TC en la numerosa población de pacientes con trauma craneal leve ha llevado a diagnosticar un número creciente de hematomas asintomáticos.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En contra del tratamiento conservador de estas colecciones hemorrágicas intracraneales se ha aducido que su presencia siempre conlleva riesgo potencial de deterioro tardío que puede resultar irreversible, y que en cualquier caso el tratamiento no quirúrgico acarrea costes globales más elevados que el tratamiento quirúrgico convencional. En esta revisión se analizan los criterios utilizados por diferentes autores para establecer la indicación de tratamiento inicial conservador de pacientes no comatosos con hematomas extracerebrales, así como las pautas de seguimiento clínico y radiológico a aplicar hasta que se comprueba la desaparición definitiva del hematoma.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The extensive use of computerized tomography (CT) in mild head injury patients has led to discover an increasing number of asymptomatic or minimally symptomatic extracerebral hematomas. When facing such «occult» hematomas the surgeon has to decide whether to operate in order to prevent delayed neurological deterioration. The experience gained in many centers has demonstrated that in selected cases small or even moderately large extracerebral hematomas can be safely managed without surgery provided that an adequate regime for neurological surveillance and serial CT scanning is adopted until the hematoma is definitively reabsorved. However, the criteria for taking the non surgical option are not yet clearly defined.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Against the conservative treatment of extracerebral hematomas it has been argued that it carries both an unnecessary risk for the patient and greater costs than does the surgical option. In this review we analyze the publications related with the conservative management of extracerebral hematomas in non comatose patients and comment on the clinical and radiological criteria used by different authors for making the selection of non surgical candidates.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Lobato, R.D.; Servadei, F.; Gómez, P.A.; González, P.: Tratamiento no quirúrgico de los hematomas epidurales y subdurales de pequeño y mediano tamaño. Criterios para la selección y seguimiento de los pacientes. Neurocirugía 1997; 8: 16–24.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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