Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Via Conca #71, 60020, Ancona, Italy.
Department of Neurosurgery of Institute for Scientific and Care Research "ASMN", Neurosurgery-Neurotraumatology Unit of University Hospital of Parma, Reggio Emilia, Italy.
Neurosurg Rev. 2020 Jun;43(3):893-901. doi: 10.1007/s10143-019-01083-7. Epub 2019 Feb 4.
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.
创伤后颅上和颅下急性硬膜外血肿（SIEDH）是一种罕见的硬膜外血肿类型，仅有少数小系列报道。在此情况下，本研究旨在介绍我们治疗 8 例急性 SIEDH 的经验，并进行系统的文献复习。我们回顾性分析了在我科接受 SIEDH 手术的 8 例患者的临床和影像学资料。使用 PRISMA 指南，我们检索了 1990 年 1 月至 2018 年 1 月期间发表的关于 SIEDH 的文章。共有 3 篇文章符合纳入标准并进行了分析。SIEDH 的发病率非常低，占所有外伤性硬膜外血肿（EDH）的<2%。SIEDH 与非特异性症状相关。只有 20%的患者在入院时昏迷（GCS<8）。未报告“清醒间歇期”。由于以下原因，所有病例的出血来源均为静脉性：板障出血导致骨折（50%）、横窦/乙状窦损伤（22%）、脑膜静脉血管渗血（8%）、横窦游离而无壁损伤（6%），其他病例不详。由于出血来源为静脉性，SIEDH 的临床表现可能发展缓慢，但一旦血肿达到临界量，病情迅速恶化并导致急性脑干压迫，可能致命。手术是治疗 SIEDH 的主要方法：本综述共纳入 42 例 SIEDH 患者，其中 40 例（95.23%）接受手术治疗，仅 2 例保守治疗。在我们的系列中，所有患者均接受了手术治疗。最常用和安全的手术方法是行额顶开颅术和枕下入路开颅术，在横窦上方保留骨桥以进行硬脑膜悬吊缝线。SIEDH 是一种罕见的 EDH 类型。早期诊断 SIEDH 并及时行联合额顶和枕下入路血肿清除术可获得良好的恢复。
