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01-06-2020 | Craniotomy | Review

Surgical management of traumatic supra and infratentorial extradural hematomas: our experience and systematic literature review

Authors: Davide Nasi, Corrado Iaccarino, Antonio Romano, Pasquale De Bonis, Marco Farneti, Franco Servadei, Reza Ghadirpour

Published in: Neurosurgical Review | Issue 3/2020

Abstract

Post-traumatic supra and infratentorial acute extradural hematomas (SIEDHs) are an uncommon type of extradural hematoma with only few small series published. In this scenario, the purposes of the present study are to present our experience in the management of 8 patients with acute SIEDH and to perform a systematic literature review. The clinical and radiological data of 8 patients operated for SIEDH at our department were analyzed retrospectively. Using the PRISMA guidelines, we reviewed the articles published from January 1990 to January 2018 reporting data about SIEDH. A total of 3 articles fulfilled the inclusion criteria and were analyzed. The incidence of SIEDHs is very rare constituting < 2% of all traumatic extradural hematomas (EDH). SIEDHs are associated with non-specific symptoms. Only 20% of patients were in coma (GCS < 8) at admission. A “lucid interval” was not reported. The source of bleeding of SIEDH was venous in all cases due to the following: bone fracture with diploe bleeding (50%), transverse/sigmoid sinus injury (22%), oozing meningeal venous vessel (8%), detachment of transverse sinus without wall injury (6%), and unknown in the other cases. Due to the venous nature of the source of hemorrhage, the clinical manifestation of a SIEDH may develop in a slow way, but once a critical volume of hematoma is reached, the deterioration can become rapid and fatal for acute brain stem compression. Surgery is the mainstay of SIEDHs treatment: among 42 cases with SIEDH included in this review, 40 (95.23%) patients were treated with surgery while only two were managed conservatively. Also in our series, all patients underwent surgery. A combined supratentorial craniotomy and suboccipital craniotomy leaving in a bone bridge over the transverse sinus for dural tenting sutures resulted the most used and safe surgical approach. SIEDH is a rare type of EDH. Early diagnosis of SIEDH and prompt surgical evacuation with a combined supratentorial and suboccipital approach provide excellent recovery.

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Title: Surgical management of traumatic supra and infratentorial extradural hematomas: our experience and systematic literature review
Authors: Davide Nasi
Corrado Iaccarino
Antonio Romano
Pasquale De Bonis
Marco Farneti
Franco Servadei
Reza Ghadirpour
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Craniotomy
Hematoma
Coma
Published in: Neurosurgical Review / Issue 3/2020
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-019-01083-7

At a glance: The STEP trials

Springer Medicine

Surgical management of traumatic supra and infratentorial extradural hematomas: our experience and systematic literature review

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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