Kotani Saki, Murakami Nobukuni, Doi Tomoyuki, Ogawa Takahiro, Hashimoto Naoya
Department of Neurosurgery, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
Department of Neurosurgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Sciences, Kyoto, Japan.
Surg Neurol Int. 2023 Feb 24;14:73. doi: 10.25259/SNI_1010_2022. eCollection 2023.
The appropriate timing and method of surgery for vertex epidural hematoma (VEDH) are uncertain due to the presentation and slow symptomatic exacerbation caused by bleeding from a venous origin involving the injured superior sagittal sinus (SSS). Coagulation and fibrinolytic disorders that occur after traumatic brain injury also worsen bleeding. For these reasons, it is challenging to decide the surgical procedure and timing of surgery.
A 24-year-old man involved a car accident and was transported to our emergency department. He was unconscious but not lethargic. Computed tomography showed VEDH overlying the SSS, and hematoma increased temporarily. Due to abnormal coagulation and fibrinolysis at admission, he underwent intentionally delayed surgery after control of coagulation and fibrinolysis. Bilateral parasagittal craniotomy was chosen to ensure hemostasis from the torn SSS. The patient improved without complications and was discharged with no neurological deficit. This case indicates that this surgical strategy is favorable for VEDH with slow symptomatic progression.
VEDH is mostly caused by bleeding from the injured SSS secondary to diastatic fracture of sagittal suture. Intentionally delayed surgical intervention using bilateral parasagittal craniotomy after stabilization of coagulation and fibrinolysis is favorable for prevention of further hemorrhage and good hemostasis.
由于静脉源性出血累及受伤的上矢状窦（SSS）导致的临床表现及症状缓慢加重，顶点硬膜外血肿（VEDH）的合适手术时机和方法尚不确定。创伤性脑损伤后发生的凝血和纤溶紊乱也会使出血加重。基于这些原因，决定手术方式和手术时机具有挑战性。
一名24岁男性遭遇车祸后被送往我院急诊科。他处于昏迷状态但无嗜睡。计算机断层扫描显示在SSS上方有VEDH，且血肿暂时增大。由于入院时凝血和纤溶异常，在凝血和纤溶得到控制后，他接受了有意延迟的手术。选择双侧矢旁开颅术以确保撕裂的SSS止血。患者恢复良好，无并发症，出院时无神经功能缺损。该病例表明，这种手术策略对症状进展缓慢的VEDH是有利的。
VEDH主要由矢状缝分离性骨折继发的受伤SSS出血引起。在凝血和纤溶稳定后，采用双侧矢旁开颅术进行有意延迟的手术干预有利于预防进一步出血并实现良好止血。
