Surgery for contralateral acute epidural hematoma following acute subdural hematoma evacuation: five new cases and a short literature review

Shen, Jian; Pan, Jianwei; Fan, Zuo Xu; Zhou, Yong; Chen, Zhe; Zhan, R. Y.

doi:10.1007/s00701-012-1569-9

Cited by 49 publications

(63 citation statements)

References 25 publications

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“…However, operations for traumatic intracranial hematomas are usually unilateral. Bilateral operations have been reported in bifrontal decompressive craniectomies for brain swelling15) or sequential contralateral removal of a newly developed hematoma after a one-side evacuation of an intracranial hematoma11,16,17,20). In our series of patients over 5 years, only 1.2% of the head-injury patients with hematomas underwent simultaneous operations for bilateral intracranial hematomas in a single session.…”

Section: Discussionmentioning

confidence: 75%

See 1 more Smart Citation

Surgery for Bilateral Large Intracranial Traumatic Hematomas: Evacuation in a Single Session

Kompheak

Hwang

Kim

et al. 2014

J Korean Neurosurg Soc

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ObjectiveManagement guidelines for single intracranial hematomas have been established, but the optimal management of multiple hematomas has little known. We present bilateral traumatic supratentorial hematomas that each has enough volume to be evacuated and discuss how to operate effectively it in a single anesthesia.MethodsIn total, 203 patients underwent evacuation and/or decompressive craniectomies for acute intracranial hematomas over 5 years. Among them, only eight cases (3.9%) underwent operations for bilateral intracranial hematomas in a single session. Injury mechanism, initial Glasgow Coma Scale score, types of intracranial lesions, surgical methods, and Glasgow outcome scale were evaluated.ResultsThe most common injury mechanism was a fall (four cases). The types of intracranial lesions were epidural hematoma (EDH)/intracerebral hematoma (ICH) in five, EDH/EDH in one, EDH/subdural hematoma (SDH) in one, and ICH/SDH in one. All cases except one had an EDH. The EDH was addressed first in all cases. Then, the evacuation of the ICH was performed through a small craniotomy or burr hole. All patients except one survived.ConclusionBilateral intracranial hematomas that should be removed in a single-session operation are rare. Epidural hematomas almost always occur in these cases and should be removed first to prevent the hematoma from growing during the surgery. Then, the other hematoma, contralateral to the EDH, can be evacuated with a small craniotomy.

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Section: Discussionmentioning

confidence: 75%

“…Bilateral surgery has rarely been published in case reports for sequential evolution of a contralateral hematoma after removal of a first one7,8,10,16,17,20,21). The rate of bilateral surgery in brain trauma operations cannot be estimated, but lesions requiring consecutive contralateral surgery were almost always EDHs.…”

Section: Introductionmentioning

confidence: 99%

Surgery for Bilateral Large Intracranial Traumatic Hematomas: Evacuation in a Single Session

Kompheak

Hwang

Kim

et al. 2014

J Korean Neurosurg Soc

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“…EDH is extremely rare, with only 38 cases after decompressive craniectomy presented in the literature. [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.…”

Section: Discussionmentioning

confidence: 99%

“…The main cause appears to be corrupted equilibrium of the injured vessels and reactive ICP. 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%

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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“…Patients with such indications experience a worse condition of unconsciousness and display lateralizing signs, thus require immediate surgical intervention. 9,10,11,12,13 This case study has focused on recent findings in the anesthetic management of patients undergoing craniotomy while awake, and proposed a structured approach to the clinical practice of 'local anesthesia' for awake neurosurgery. The case holds a significant character as craniotomy for extradural hematoma is a common procedure under general anesthesia but for extradural hematoma craniotomy is not yet reported under local anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Surgical Evacuation Extradural Hematoma under Local Anesthesia

Qureshi¹,

Raja²,

Naim³

et al. 2017

Int. j. endorsing health sci. res.

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Extradural hematoma as a result of traumatic injury is a serious neurological emergency that required immediate intervention. The standard protocol is to identify the condition at earliest and provide quick surgical evacuation of the hematoma. The situation tends to be fatally deteriorating and marks a high mortality rate and worse health outcomes. We have presented a case of extradural hematoma in this study where the surgery had a delay due to the unavailability of general anesthesia. However, the falling Glasgow Coma Scale scores encouraged the surgeons to induce the surgical procedure with the employment of local anesthesia. The intervention turned out to be successful and produced the possibility of using local anesthesia as an alternative in case of critical emergency situations in order to save a life.

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Surgery for contralateral acute epidural hematoma following acute subdural hematoma evacuation: five new cases and a short literature review

Cited by 49 publications

References 25 publications

Surgery for Bilateral Large Intracranial Traumatic Hematomas: Evacuation in a Single Session

Surgery for Bilateral Large Intracranial Traumatic Hematomas: Evacuation in a Single Session

Epidural hematoma: postoperative complication

Surgical Evacuation Extradural Hematoma under Local Anesthesia

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