The surgical management of intracranial hematomas in hemophiliac children

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Abstract
A prospective study was undertaken to treat all intracranial hematomas in hemophiliac A children under a uniform protocol. Patient selection was obtained by (1) early CT scan of all hemophiliacs presenting with neurological symptoms and (2) routine hematological screening for coagulopathies of all pediatric intracranial hematomas, spontaneous or traumatic. Nine patients, of whom seven came under category 1 and two under category 2, were entered into this study. There were eight subdural hematomas, one epidural hematoma, and one intracerebral hematoma. Surgery was required in every patient. Human factor VIII concentrate was used for replacement up to 100% just before and 3 days after surgery. Thereafter, it was maintained at 50% up to the 10th postoperative day. There was no operative or late mortality. At 6-month follow-up, eight of nine patients had recovered completely with no residual neurological deficit. We conclude that early diagnosis, prompt surgical intervention, and perfect normalization of hemostatic defect are essential in improving the outcome of these patients.