Abstract
Traumatic intracranial epidural hematoma (EDH) and subdural hematoma (SDH) represent potentially emergent surgical lesions. Underlying traumatic brain injury can occur with either EDH or SDH but is more commonly associated with SDH. Workup involves detailed trauma evaluation and resuscitation and neurological examination, followed by rapid CT scanning. Surgical considerations include volume and location of lesions, degree of mass effect, clinical examination, and other injuries and insults. Patients who are actively deteriorating neurologically should undergo emergent craniotomy when that deterioration is related to an initially large or expanding extra-axial mass lesion. Bone flaps are generally able to be replaced when evacuating epidural hematomas. The decision on whether to leave off the bone flap in the case of SDH is made at surgery, though several radiographic and clinical predictors exist. Intracranial pressure monitoring is a mainstay of management in severe traumatic brain injury and when initial observation of extra-axial hematomas is employed.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Chesnut RM, Marshall SB, Piek J, Blunt BA, Klauber MR, Marshall LF. Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl (Wien). 1993;59:121–5.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–4.
Miller PR, Fabian TC, Croce MA, Cagiannos C, Williams JS, Vang M, et al. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg. 2002;236(3):386–93; discussion 93–5.
Miller PR, Fabian TC, Bee TK, Timmons S, Chamsuddin A, Finkle R, et al. Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma. 2001;51(2):279–85; discussion 85–6.
Holly LT, Kelly DF, Counelis GJ, Blinman T, McArthur DL, Cryer HG. Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics. J Neurosurg. 2002;96(3 Suppl):285–91.
Dolinskas CA, Zimmerman RA, Bilaniuk LT, Gennarelli TA. Computed tomography of post-traumatic extracerebral hematomas: comparison to pathophysiology and responses to therapy. J Trauma. 1979;19(3):163–9.
Sharma OP, Oswanski MF, Yazdi JS, Jindal S, Taylor M. Assessment for additional spinal trauma in patients with cervical spine injury. Am Surg. 2007;73(1):70–4.
Miller CP, Brubacher JW, Biswas D, Lawrence BD, Whang PG, Grauer JN. The incidence of noncontiguous spinal fractures and other traumatic injuries associated with cervical spine fractures: a 10-year experience at an academic medical center. Spine (Phila Pa 1976). 2011;36(19):1532–40.
Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3 Suppl):S16–24; discussion Si–iv.
Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute epidural hematomas. Neurosurgery. 2006;58(3 Suppl):S7–S15; discussion Si–iv.
Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27(8):1304–5.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Timmons, S.D. (2022). Acute Extra-Axial Hematoma. In: Raksin, P.B. (eds) Acute Care Neurosurgery by Case Management. Springer, Cham. https://doi.org/10.1007/978-3-030-99512-6_1
Download citation
DOI: https://doi.org/10.1007/978-3-030-99512-6_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-99511-9
Online ISBN: 978-3-030-99512-6
eBook Packages: MedicineMedicine (R0)