Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
Clin Neurol Neurosurg. 2021 Jan;200:106369. doi: 10.1016/j.clineuro.2020.106369. Epub 2020 Nov 13.
Bicompartmental Supra plus Infratentorial Extra Dural Hematoma (SIEDH) is an uncommon yet important category of Extradural Hematoma (EDH) straddling the transverse sinus. It requires quick decision making and proper surgical evacuation.
We did a retrospective chart review of all SIEDH cases from prospectively maintained operative database in our institute between 2011 & 2017. Clinical status at discharge and follow up were used to assess outcome. Ordinal regression analysis was used for analysis of factors predicting the outcome. We also describe the surgical procedure we follow at our high-volume trauma center for this unique entity.
We had 61 operated cases of SIEDH in our series. The median age of the cohort was 30 years (IQR: 21.5-42). Road Traffic Accident was the most common mode of injury (67.2 %). Median pre-operative GCS was 12 (IQR: 9-12). The median volume of SIEDH was 50cc (IQR: 40-70). Mass effect on 4ventricle and brainstem was seen in 47 and 34 patients respectively. An associated fracture was seen in 54 patients. Sinus injury related bleed was noted intra-operatively in 57 % (N = 35). Follow up was available for 60 cases with a median of 130 days. On evaluating with ordinal regression analysis, we found that, the GCS at presentation, pupillary asymmetry, volume of SIEDH, infratentorial volume, blood loss and mass effect on 4ventricle were statistically significant factors affecting GCS at discharge. However, the GCS at presentation, infratentorial volume and blood loss were the only factors determining GOS at follow-up.
SIEDH are uncommon yet important type of injury type which requires prompt attention and appropriate nuanced approach. Large SIEDH are commonly associated with sinus injury, and large volume blood loss may be anticipated. In addition, SIEDH may be associated with other traumatic brain injuries which may require surgical evacuation.
双腔幕上-幕下硬膜外血肿（SIEDH）是一种罕见但重要的硬膜外血肿（EDH）类别，横跨横窦。它需要快速决策和适当的手术清除。
我们对 2011 年至 2017 年期间在我们研究所前瞻性维护的手术数据库中所有 SIEDH 病例进行了回顾性图表审查。使用出院和随访时的临床状况来评估结果。使用有序回归分析来分析预测结果的因素。我们还描述了我们在高容量创伤中心对这种独特实体采用的手术程序。
我们的系列中有 61 例 SIEDH 手术病例。队列的中位年龄为 30 岁（IQR：21.5-42）。道路交通伤害是最常见的受伤模式（67.2%）。术前 GCS 中位数为 12（IQR：9-12）。SIEDH 的中位数体积为 50cc（IQR：40-70）。4 脑室和脑干受压分别见于 47 例和 34 例患者。54 例患者存在相关骨折。术中发现 57%（N=35）存在窦损伤相关出血。60 例患者可获得随访，中位随访时间为 130 天。通过有序回归分析，我们发现，入院时的 GCS、瞳孔不对称、SIEDH 体积、幕下体积、失血量和 4 脑室受压是影响出院时 GCS 的统计学显著因素。然而，入院时的 GCS、幕下体积和失血量是决定随访时 GOS 的唯一因素。
SIEDH 是一种罕见但重要的损伤类型，需要迅速关注并采取适当的细致方法。大体积 SIEDH 通常与窦损伤相关，并可能预期大量失血。此外，SIEDH 可能与其他需要手术清除的外伤性脑损伤相关。
