Aoki Taisei, Higuchi Tadashi, Nounaka Yohei, Matano Fumihiro, Nakae Ryuta, Igarashi Yutaka, Yokobori Shoji, Murai Yasuo
Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan.
J Neurosurg Case Lessons. 2025 Mar 24;9(12). doi: 10.3171/CASE24756.
An acute epidural hematoma (AEDH) is a severe complication of traumatic brain injury, occurring in 1%-3% of all head trauma cases. Herein, the authors report a rare case of AEDH in a 51-year-old male, with the AEDH extending bilaterally across the superior sagittal sinus (SSS) and into the infratentorial region following a fall.
The patient underwent an emergency craniotomy and hematoma evacuation, and favorable outcomes were achieved.
This case highlights the importance of utilizing surgical and skin incision positions that allow for adequate removal of AEDH and show the effectiveness of prompt surgical intervention. Bleeding from the venous sinus is common in epidural hematomas that extend above and below the dural tentorium and to both sides of the SSS. To ensure adequate hemostasis, the bony flap near the venous sinus should be preserved to achieve hemostasis. Excessive compression of the venous sinus should be avoided to prevent obstruction. If time permits, the morphology of the dural sinus should be confirmed through CT venography or MR venography. After craniotomy, the patient should be positioned to avoid air embolization from the site of venous sinus injury. https://thejns.org/doi/10.3171/CASE24756.
急性硬膜外血肿（AEDH）是创伤性脑损伤的一种严重并发症，在所有头部外伤病例中发生率为1%-3%。在此，作者报告一例罕见的51岁男性急性硬膜外血肿病例，该患者在跌倒后硬膜外血肿双侧延伸越过矢状窦（SSS）并进入幕下区域。
患者接受了急诊开颅血肿清除术，并取得了良好的效果。
该病例强调了采用能充分清除急性硬膜外血肿的手术和皮肤切口位置的重要性，并显示了及时手术干预的有效性。在硬膜外血肿延伸至硬脑膜小脑幕上下及矢状窦两侧的情况下，静脉窦出血很常见。为确保充分止血，应保留静脉窦附近的骨瓣以实现止血。应避免过度压迫静脉窦以防止阻塞。如果时间允许，应通过CT静脉造影或MR静脉造影确认硬脑膜窦的形态。开颅术后，患者的体位应避免静脉窦损伤部位发生空气栓塞。https://thejns.org/doi/10.3171/CASE24756
