Contralateral extradural hematoma following decompressive craniectomy for acute subdural hematoma (the value of intracranial pressure monitoring): a case report

Meguins, Lucas Crociati; Sampaio, Gustavo Botelho; Abib, Eduardo; Adry, Rodrigo Antonio Rocha da Cruz; Ellakkis, Richam Faissal El Hossain; Ribeiro, Filipe Webb Josephson; Maset, Angelo L.; Morais, Dionei Freitas de

doi:10.1186/1752-1947-8-153

Cited by 9 publications

(9 citation statements)

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“…Few cases of contralateral EDH following decompressive surgery for TBI have been reported. 5 EDH is commonly seen in neurosurgical practice, but in this report, we present two extremely rare cases and causes of postoperative EDH.…”

Section: Introductionmentioning

confidence: 83%

“…[25][26][27][28][29][30] Panourias et al, Matsuno et al, and Meguins et al reported contralateral epidural hematoma after decompressive craniectomy for acute subdural hematoma. 5,31,32 Shen et al evaluated published data via Pubmed and found a rate of 2.4% for contralateral EDH after acute subdural hematoma. The average patient age was 35, males were in the majority and the main cause of injury was traffic accident.…”

Section: Discussionmentioning

confidence: 99%

“…29 Meguins et al recommends intracranial pressure monitoring of TBI patients, even if decompressive surgery is performed. 26 Possible sources of bleeding include a ruptured meningeal arterial branch, venous lacerations and skull fractures.…”

Section: Discussionmentioning

confidence: 99%

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Epidural hematoma: postoperative complication

et al. 2017

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Epidural hematoma is an indication for emergency neurosurgical intervention. This condition is an extremely rare postoperative complication of ventriculoperitoneal shunt and contralateral decompressive craniectomy. A 22-year-old male patient was admitted to our clinic with headache and a decline in the level of consciousness. We detected a left thalamic astrocytoma and hydrocephalus, which we treated via ventriculoperitoneal shunt surgery and ventricular drainage in emergency conditions. The patient experienced dysphasia on the first postoperative day and we found a right frontoparietal epidural hematoma. We evacuated the hematoma and exchanged the medium pressure valve for a high-pressure valve. The second patient was a 19-year-old male who had been assaulted. His pupils were fixed and dilated and had no reaction to painful stimulus. We detected bilateral frontotemporal skull fractures and right frontotemporoparietal subdural and epidural hematomas. We performed a right decompressive craniectomy and subdural/epidural hematoma evacuation followed by recovery under sedation in the intensive care unit. We performed cranial computed tomography six hours after surgery and found a left temporoparietal epidural hematoma. We performed a left temporoparietal craniotomy and epidural hematoma evacuation. The patient exhibited a higher level of consciousness and increased movement of his extremities. Epidural hematoma is a life-threatening complication encountered in neurosurgery practice. Neurosurgeons should be aware of the possibility of epidural hematoma following ventriculoperitoneal shunt or traumatic brain injury surgery.

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Section: Introductionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Epidural hematoma: postoperative complication

et al. 2017

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“…A maioria dos trabalhos coletados foram relatos de casos 3,6,10,23,24,26,29,35 e estudos observacionais com análise retrospectiva 17,22,38,42,43,47 . As observações radiológicas com maior significância foram relatadas por Talbott et al 43 .…”

Section: Características Gerais Dos Estudosunclassified

“…Uma das complicações com desfecho mais desfavorável, secundário a CD, é o desenvolvimento de HE contralateral durante ou nas horas seguintes a cirurgia 17,22,23,24,26,33 . A formação de HE no trauma é comum 20 , entretanto, quando secundário a CD, observamos uma taxa de incidência significantemente menor 43 .…”

Section: B) Anormalidade Pupilarunclassified

Características do Hematoma Epidural Contralateral após Craniectomia Descompressiva para Tratamento de Trauma Cranioencefálico Grave. Revisão Sistemática

Moreira¹,

Adry²,

Pereira³

2018

jbnc

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Introdução: A craniectomia descompressiva é considerada como o método cirúrgico mais utilizado no tratamento da hipertensão intracraniana refratária decorrente da injúria cerebral grave. Apesar de ser descrita como método resolutivo quando bem indicado, pode contar com severas complicações precoces, destacando-se dentre elas o hematoma epidural contralateral. Objetivos: Descrever os principais achados clínicos e tomográficos de pacientes que apresentaram hematoma epidural contralateral após a realização da craniectomia descompressiva para tratamento do trauma cranioencefálico grave. Metodologia: Trata-se de uma revisão sistemática de literatura, sem metanálise, realizada pelas bases de dados Pubmed e Scielo. Resultados: Foram encontrados sessenta e sete pacientes acometidos por hematoma epidural contralateral após a realização da craniectomia descompressiva. A suspeição para a formação do novo sangramento foi observada pela anormalidade pupilar (22,3%) e aumento da pressão intracraniana (18%) no pós-operatório, pelo inchaço cerebral no momento da primeira cirurgia (22,3%) ou revelado pela tomografia computadorizada de rotina (26,8%). Pelo menos 86,36% dos pacientes apresentaram fratura óssea contralateral ao hematoma inicial. Conclusão: O hematoma epidural contralateral tem uma incidência de 5,2%. A fratura óssea contralateral ao hematoma inicial se destaca como principal característica para o desenvolvimento de hematoma epidural contralateral. O edema cerebral intra-operatório inexplicável ou a presença de anormalidades pupilares no pós-operatório, se destacam como bom indicador do desenvolvimento do hematoma contralateral. Em contrapartida, a deterioração neurológica e a presença de coagulopatias não é uma característica confiável de hematoma epidural contralateral após craniectomia descompressiva.

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Contralateral epidural hematoma after decompressive surgery: Case report and systematic literature review

Laaidi

Rafiq

Tahrir

et al. 2022

Annals of Medicine &Amp; Surgery

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Introduction and importance: Contralateral epidural hematoma (EDH) after decompressive surgery for acute subdural hematoma (ASDH) is uncommon. If unrecognized, this delayed hematoma can lead to devastating consequences. Case presentation A 30-year-old patient with no past medical history, was brought to the emergency after a severe brain injury secondary to an aggression, Glasgow coma scale was 6 (E1V1 M4) with a left anisocoria. The CT scan revealed a left acute subdural hematoma with midline shift superior than 10 mm, and a non-surgical contralateral EDH was also identified. The patient was operated on urgently. Post-operatively, the pupils became equal sized and reactive. A right anisocoria was noticed 12 h later, with a large contralateral EDH on CT scan associated to a gross midline shift. A second operation was performed immediately with a good recovery and the patient was extubated one week post-operatively. Clinical discussion The most common surgical complications after a decompressive craniectomy for an acute subdural hematoma noted in literature are surgical site herniation, post-operative infections, epilepsy, and subdural effusions with or without hydrocephalus. Contralateral epidural hematoma (EDH) after decompressive craniectomy is also documented (Ban et al., 2010; Nadig and King, 2012) [3,15] , however it's rare with only 100 cases, including the present one reported . Conclusions Delayed contralateral EDH after decompressive surgery should be anticipated in the presence of contralateral skull fracture and/or intraoperative brain swelling and immediate postoperative scan is indicated. Early detection of this fatal complication and prompt treatment may improve the poor outcome in this group of patients.

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Contralateral extradural hematoma following decompressive craniectomy for acute subdural hematoma (the value of intracranial pressure monitoring): a case report

Cited by 9 publications

References 15 publications

Epidural hematoma: postoperative complication

Epidural hematoma: postoperative complication

Características do Hematoma Epidural Contralateral após Craniectomia Descompressiva para Tratamento de Trauma Cranioencefálico Grave. Revisão Sistemática

Contralateral epidural hematoma after decompressive surgery: Case report and systematic literature review

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