Conservative management of extradural haematomas: Effects of skull fractures on resorption rate

Tuncer, Recai; Açikbas, Cem; Uçar, Tanju; Kazan, Saim; Karasoy, M; Saveren, M.

doi:10.1007/bf01844752

Cited by 16 publications

(15 citation statements)

References 20 publications

(32 reference statements)

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“…Since this area was filled with the venous blood of the basilar plexus dynamically, why does the blood not continue to fill the space? An epidural hematoma at the lateral calvarial region could be resolved spontaneously, because there is no venous sinus below (6,28). It is possible that initial trauma causes bleeding at the outset, from the basilar plexus, but when the hematoma creates a sufficient level of pressure, cessation of bleeding may result.…”

Section: Discussionmentioning

confidence: 99%

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Ayberk¹,

Özveren²,

Aslan³

et al. 2011

Turkish Neurosurgery

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AIm:We aimed to show the significance of the anterior pontine membrane as a determining structure between the subdural and subarachnoid space in the clival region. mAterIAl and methOds: Five adult cadaver heads and five cerebral hemispheres were used. The skull vault and hemipheres were removed by sectioning through the pontomesencephalic junction. Five other heads hemispheres were removed but the arachnoid membrane was protected and the cerebral side of the clival dura mater was dissected. In another specimen, the dural porus of the abducens nerve was sectioned for histological evaluation. Three cases of hematoma at the clivus were presented to support our findings. results:The anterior pontine membrane is the arachnoid membrane forming the anterior wall of the prepontine cistern with its lateral extension at the skull base. This membrane forms the subdural and subarachnoid spaces by forming a barrier between the clival dura mater and neurovascular structures of the brainstem. There were rigid fibrous trabeculations between both cerebral and periosteal dural layers forming the basilar plexus as the interdural space in the clivus. COnClusIOn:The anterior pontine membrane separates the subdural and subarachnoid spaces at the clival region. The hematomas of the clival region require to be evaluated with consideration given to the existance of the subdural space.KeywOrds: Anterior pontine membrane, Arachnoid, Clivus, Interdural space ÖZ AmAÇ: Bu çalışmada, klival bölgedeki subdural ve subaraknoid mesafenin belirlenmesinde anterior pontin membranın önemini göstermek istedik. yÖntem ve GereÇ: Çalışmada beş yetişkin kadavranın kafatası ve beş serebral hemisfer kullanılmıştır. Kafatası ve hemisferler pontomezensefalik bileşke boyunca kesilerek çıkarılmıştır. Diğer beş hemisfer, araknoid membran korunarak çıkarılmış ve klival duramaterin serebral kısmı diseke edilmiştir. Bir başka spesmende, abdusens siniri dural porusu civarında histolojik kesit almak için kesilmiştir. Bulguları desteklemek için üç klival hematom vakası sunulmuştur.BulGulAr: Anterior pontin membran, prepontin sisternin anterior duvarını oluşturur ve kafa kaidesinin lateraline doğru uzanır. Bu membran, beyin sapının nörovaskuler yapıları ve klival dura dura mater arasında bariyer oluşturarak, subdural ve subaraknoid mesafenin oluşmasını sağlar. Klivusta baziler pleksusu oluşturan serebral ve periostal dural tabakalar arasında rijit fibröz trabekülasyonlar vardı. sOnuÇ: Anterior pontin membran, klival bölgede subdural ve subaraknoid mesafeleri ayırır. Klival bölgedeki hematomların, subdural mesafenin varlığı göz önüne alınarak değerlendirilmesi gerekir.

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Section: Discussionmentioning

confidence: 99%

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Ayberk¹,

Özveren²,

Aslan³

et al. 2011

Turkish Neurosurgery

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“…Another mechanism for the resolution of extradural blood is the evacuation through overlying skull fractures that commonly accompany EDH. Tuncer et al [21] reported a higher rate of spontaneous resorption in patients with additional skull fracture compared to pa-…”

Section: Discussionmentioning

confidence: 99%

“…Mass effect is seen frequently [20]. Additional skull fractures were seen in 65-100% of cases with acute EDH in different series [21].…”

Section: Introductionmentioning

confidence: 99%

Possible Mechanisms for Rapid Spontaneous Resolution of Acute Epidural Hematomas

Wagner

Freudenstein

Friese

et al. 2002

Klinische Neuroradiologie

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Background: Acute epidural hematomas (EDH), often associated with additional cranial and extracranial injury, are a serious condition which requires immediate surgical evacuation. Otherwise there is a high risk of quick deterioration and death. Only small asymptomatic hematomas can be treated conservatively with close observation. Case Report: We present a case of complete resolution of a traumatic posterior fossa EDH within 1 hour. Conclusion: Several possible mechanisms of spontaneous resorption are discussed with a review of literature regarding the conservative treatment of acute epidural hemorrhage. This is the first description of the spontaneous resolution of an acute traumatic EDH within 1 hour. Mögliche Wege der raschen spontanen Resorption von akuten epiduralen Hämatomen. Fallbericht und LiteraturübersichtZusammenfassung Hintergrund: Akute traumatische, epidurale Hämatome sind häufig eine lebensbedrohliche Erkrankung. Sie erfordern eine rasche neurochirurgische Behandlung durch Hämatomausräumung, da sich der klinische Zustand des Patienten sonst in kurzer Zeit verschlechtern und die Raumwirkung des Hämatoms auf das Gehirn zum Tode führen kann. Nur kleine epidurale Hämatome, die sich klinisch asymptomatisch darstellen, können konservativ erfolgreich behandelt werden. Eine engmaschige Überwachung der Patienten ist jedoch erforderlich. Fallbeschreibung: Wir berichten über einen Patienten mit einem ausgedehnten traumatischen epiduralen Häma-tom in der hinteren Schädelgrube, das sich innerhalb einer Stunde spontan resorbierte. Schlussfolgerungen: Es werden mögliche Resorptionsmechanismen beschrieben und die vorhandene Literatur zur konservativen Behandlung akuter epiduraler Hämatome besprochen. Die vorliegende Arbeit befasst sich erstmals mit der spontanen Resorption eines akuten traumatischen epiduralen Hämatoms innerhalb 1 Stunde. Schlüsselwörter: Akutes epidurales Hämatom · Spontane Resorption · Intrakranielle Verletzung · Konservative Behandlung von epiduralen Hämatomen

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“…In the past these hematoma were occasionally discovered even some weeks after the injury during the course of neurosurgery for other reason namely dural plastic surgery of ACF. Some expressed doubts concerning the need to remove EDH in patients affected by subjective disorders only and without neurological deficits [20], One of the several mechanisms to explain the resorption of the hematoma was the transfer of the clot into the epicranial space through the skull fracture [21].…”

Section: Vmentioning

confidence: 99%

Traumatic Extradural Hematoma – Our Comparative Experience between Conservative and Surgical Management in Rural India

Ugane¹,

Qazi²

2012

IOSR-JDMS

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Conservative management of extradural haematomas: Effects of skull fractures on resorption rate

Cited by 16 publications

References 20 publications

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Possible Mechanisms for Rapid Spontaneous Resolution of Acute Epidural Hematomas

Traumatic Extradural Hematoma – Our Comparative Experience between Conservative and Surgical Management in Rural India

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