Surgical treatment of supra- and infratentorial epidural hematoma

Abstract

Supra-and infratentorial acute epidural hematoma (SIEDH) is a common type of posterior fossa epidural hematoma (PFEDH), representing 11-64% of all PFEDHs. Although SIEDH is associated with typical characteristics, it might be difficult to diagnose when presenting as infratentorial acute epidural hematoma, which is clinically silent and has nonspecific symptoms. However, this type of hematoma can often be rapidly deteriorating, causing a sharp rise in intracranial pressure that leads to a life-threatening foramen magnum herniation. Early diagnosis and management of SIEDH are imperative. Traditional surgical management has always required relatively large craniotomies, larger than the hematoma itself, to expose its edge, and then tack up the dura matter). It usually opens the window and emphasizes retention of the bone bridge outside the transverse sinus. This method can effectively eliminate the hematoma, but it is associated with larger postoperative wound, longer operation time, larger skull defect, and more complications. Hence, exploration into a better surgical method is direly needed.

Intracranial epidural hematoma after use of a 3-pin head clamp in a pediatric case with posterior fossa tumor and hydrocephalus: A case report

“…According to the results of this study, especially in pediatric cases, the complications of the 3 pin head clamps are not as low as expected according to the literature. We think that this difference may occur as a result of surgeons avoiding reporting complications [11][12][13].…”

Traumatic supra- and infra-tentorial extradural hematoma: Case series and literature review

“…[ 9 ] TSIEDH mainly occurs due to occipital deceleration injury, most often associated with occipital bone fracture or lambdoid suture separation. [ 3 9 11 ] Venous sinus detachment, meningeal blood vessels leakage, and a fracture line across the transverse sinus all lead to TSIEDH. [ 11 ] In our series, two cases had lambdoid suture separation and one case had occipital bone fracture.…”

“…[ 3 ] Although TSIEDH has associated typical characteristics, it might be difficult to diagnose as infratentorial acute EDH is clinically silent and has nonspecific symptoms. [ 11 ] Infratentorial hematoma can lead to sudden death and quick deterioration while supratentorial hematoma can mask the features of infratentorial hematoma. [ 9 ] An external injury to the occipital region, consisting of bruising, laceration, or cephalohematoma, can be the key finding in a head trauma that becomes complicated with a TSIEDH without specific neurological features.…”

“…The reason why early surgery should be performed in patient with TSIEDH is to eliminate the hematoma and lift the compression to the transverse sinus. [ 11 ] If the transverse sinus is compressed, causing venous return disorder, the symptoms of intracranial hypertension can be significant and can rapidly form tonsillar herniation, which is difficult to resolve. In general, overall mortality of TSIEDH is 17%, the operative mortality rate is 14%, and the morbidity rate is 6%.…”

“…In our series, there was one case with lethal outcome. [ 11 ] Poor initial GCS, old age, and delayed time to surgical intervention were factors of bad prognosis for the patient. In relation to the associated intracranial lesions coexisting with TSIEDH, we found ICH in one case and brain edema in two cases.…”