Surgery or conservative treatment in children with traumatic intracerebralhaematoma

In contrast to the case of extracerebral haematomas, the criteria for opera tive treatment of traumatic intracerebral haematoma (TIH) are not clear. Th e purpose of this study was to find factors that would be helpful in reachi ng a decision for surgical or conservative treatment of TIH. We performed a retrospective analysis of 31 consecutive cases of TIH treated in our depar tment. The following factors were estimated: age, mechanism of injury, init ial GCS or CCS score, neurological deficits, coexistence of arterial hypote nsion and respiratory disturbances, and localisation and size of the haemat oma. The outcome was evaluated according to a modified GOS. Treatment was s urgical for 20 patients and conservative for 11. Patients with GCS or CCS s cores of 3-8 were treated surgically significantly more often than those wi th higher scores. The other factors did not correlate with type of treatmen t. It seems, then, that the clinical status of the patient, especially the level of consciousness according to the GCS or CCS score, is the most impor tant predictor of the need for surgery in children with TIH.