Masmoudi Mourad, Gader Ghassen, Slimane Abdelhafidh, Rkhami Mouna, Badri Mohamed, Bahri Kamel, Zammel Ihsèn
Department of Neurosurgery, Trauma and Burns Center, Faculty of Medicine of Tunis, University Tunis-El Manar, Ben Arous, Tunisia.
Department of Neurosurgery, National Institute of Neurology, Faculty of Medicine of Tunis, University Tunis-El Manar, Tunis, Tunisia.
Korean J Neurotrauma. 2023 Dec 8;19(4):487-495. doi: 10.13004/kjnt.2023.19.e60. eCollection 2023 Dec.
Supratentorial-infratentorial epidural hematomas (SIEH) are a rare occurrence following traumatic head injuries, representing only 2% of traumatic epidural hematomas. Given the unique anatomical characteristics of the infratentorial region, mainly its small size, surgical intervention is commonly undertaken to alleviate the pressure on the posterior fossa components. Consequently, there is ongoing debate surrounding the optimal surgical approaches.In this report, we present four cases of SIEH that were treated surgically. Furthermore, we conduct a comprehensive review of existing literature, encompassing clinical, radiological, and therapeutic aspects associated with this condition.SIEH are uncommon post-traumatic lesions that require urgent and individualized management on a case-by-case basis, as guided by multiplanar cerebral computed tomography scan findings. Preoperative planning is essential; however, intraoperative exploration and identification of transverse sinus and torcula lesions are crucial for optimal patient care. The surgical approach may be modified intraoperatively based on the nature and extent of these lesions. In all cases, prompt hematoma evacuation and meticulous hemostasis are the two primary objectives of this surgery.
幕上-幕下硬膜外血肿(SIEH)是创伤性头部损伤后罕见的情况,仅占创伤性硬膜外血肿的2%。鉴于幕下区域独特的解剖特征,主要是其体积小,通常会进行手术干预以减轻后颅窝结构的压力。因此,围绕最佳手术方法存在持续的争论。在本报告中,我们展示了4例接受手术治疗的SIEH病例。此外,我们对现有文献进行了全面综述,涵盖了与这种情况相关的临床、放射学和治疗方面。SIEH是罕见的创伤后病变,需要根据多平面脑计算机断层扫描结果,逐案进行紧急和个体化管理。术前规划至关重要;然而,术中探查和识别横窦和窦汇病变对于优化患者护理至关重要。手术方法可能会根据这些病变的性质和范围在术中进行调整。在所有病例中,迅速清除血肿和细致止血是该手术的两个主要目标。