University of Health Sciences Izmir Bozyaka Education and Research Hospital, Department of Neurosurgery, Izmir, Türkiye.
Turk Neurosurg. 2024;34(4):618-623. doi: 10.5137/1019-5149.JTN.43250-22.4.
To assess clinical and radiological characteristics of simultaneous acute supra- and infratentorial epidural hematomas.
We retrospectively reviewed the clinical and radiological data of 18 patients with a concomitant acute supra- and infratentorial epidural hematoma, who were treated and followed up at our hospital.
The Glasgow Coma Score was 3-8 in four patients, was 9-12 in seven, and was 13-15 in seven patients. While the concomitant supra- and infratentorial hematoma did not cross the midline in 15 of the patients, it did in three of them. The dural venous sinus rupture was repaired in five of the patients. Functional healing was observed in 14 of the 18 patients. Two of the patients died during the postoperative period.
A simultaneous supra- and infratentorial epidural hematoma rarely occurs in neurosurgical practice. Mortality and morbidity rates are high if these are not addressed in time. The radiological images of patients should be evaluated carefully preoperatively. In patients with a concomitant infra- and supratentorial hematoma, transverse sinus damage, which is a surgical challenge, should be considered. Herein, we describe a surgical technique (supra- and infratentorial craniotomy leaving the bone bridge over the transverse sinus) for draining a concomitant supra- and infratentorial epidural hematoma; this technique is an effective surgical choice in select patients.
评估同时发生的幕上和幕下硬膜外血肿的临床和影像学特征。
我们回顾性分析了 18 例同时发生的幕上和幕下硬膜外血肿患者的临床和影像学资料，这些患者在我院接受治疗和随访。
4 例患者格拉斯哥昏迷评分（GCS）为 3-8 分，7 例为 9-12 分，7 例为 13-15 分。而在 15 例患者中，同时发生的幕上和幕下血肿未越过中线，在 3 例患者中越过中线。其中 5 例患者修补了硬脑膜静脉窦破裂。18 例患者中有 14 例功能恢复良好。术后有 2 例患者死亡。
同时发生的幕上和幕下硬膜外血肿在神经外科实践中很少见。如果不能及时处理，死亡率和发病率很高。术前应仔细评估患者的影像学图像。对于同时发生的幕下和幕上血肿患者，应考虑横窦损伤，这是一个手术挑战。在此，我们描述了一种手术技术（留下横跨横窦的骨桥的幕上和幕下开颅术）用于引流同时发生的幕上和幕下硬膜外血肿；对于选择的患者，这种技术是一种有效的手术选择。
