Indication for surgical intervention in head truama

Epidural hematoma :

1. hematoma larger than 30 ml
2. midline shift >= 5 mm  

Subdural hematoma (serious and worse)

i-regardless GCS

1. hematoma larger than 1 cm
2. midline shift >=5 mm 

ii-all patients with GCS less than 9 , hematoma should be evacuated and ICP monitor be instituted.

iii- if GCS > 9 and SDH < 10mm and midline shift < 5mm , surgery is indicated if 

• GCS drops by 2 points
• new development of assymetric or dilated fixed pupils
• ICP> 20

ICH

• more than 50 ml volume and less than 85 ml
• Patients with GCS 6-8, with frontal or temporal lesion volume > 20cc with midline shift >5mm or cisternal compression.