Two cases of bilateral extradural haematomas are reported. In case I, the haematomas developed simultaneously and were probably due to a tear in the sagittal sinus. In case II, the haematomas developed sequentially and were demonstrated by serial CT scannings after the removal of a seemingly unilateral lesion. A review of the literature points out the rarity of this condition which had been described even before the CT era, with varying clinical presentations and unusually poor surgical results. The advent of the CT has made the diagnosis of simultaneous bilateral extradural haematomas easier and is regarded as a significant factor in the improvement of the prognosis noted in recent reports. However, the possibility of delayed bilateral extradural haematomas escaping detection in the initial CT should be emphasized. This unusual clinical presentation stresses the value of a routine use of serial CT scannings in the acute phase of head injuries.
A population of 41 non-hydrocephalic patients in whom a lumbo-peritoneal shunt (LPS) was inserted for various conditions is reviewed. 19 had persistent cerebro-spinal fluid rhinorrhoea following cranial injury, basal skull surgery or of unknown origin, 3 had recalcitrant benign intra-cranial hypertension, 14 had a persistent bulging craniotomy site after operations for intra-cranial tumours or head trauma, 4 had syringomyelia and 1 had a postoperative cervical meningocele. There was no shunt-related mortality. LPS was effective in treating the initial symptomatology in 31 patients. Further revision or removal of LPS were needed on 9 occasions in 8 patients showing shunt-related mechanical or infectious complications or persistent postural headaches. This report demonstrates the safety of the LPS procedure experienced in another population of 146 patients with communicating hydrocephalus operated on in the meantime. According to the authors' experience, the versatility of the clinical applications of LPS seems well established. LPS should be considered when a CSF diversion is required in patients showing absent or minimal ventricular enlargement in the CT scan.
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