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Surgical management of traumatic supra and infratentorial extradural hematomas: our experience and systematic literature review

  • Davide NasiEmail author
  • Corrado Iaccarino
  • Antonio Romano
  • Pasquale De Bonis
  • Marco Farneti
  • Franco Servadei
  • Reza Ghadirpour
Review

Abstract

Post-traumatic supra and infratentorial acute extradural hematomas (SIEDHs) are an uncommon type of extradural hematoma with only few small series published. In this scenario, the purposes of the present study are to present our experience in the management of 8 patients with acute SIEDH and to perform a systematic literature review. The clinical and radiological data of 8 patients operated for SIEDH at our department were analyzed retrospectively. Using the PRISMA guidelines, we reviewed the articles published from January 1990 to January 2018 reporting data about SIEDH. A total of 3 articles fulfilled the inclusion criteria and were analyzed. The incidence of SIEDHs is very rare constituting < 2% of all traumatic extradural hematomas (EDH). SIEDHs are associated with non-specific symptoms. Only 20% of patients were in coma (GCS < 8) at admission. A “lucid interval” was not reported. The source of bleeding of SIEDH was venous in all cases due to the following: bone fracture with diploe bleeding (50%), transverse/sigmoid sinus injury (22%), oozing meningeal venous vessel (8%), detachment of transverse sinus without wall injury (6%), and unknown in the other cases. Due to the venous nature of the source of hemorrhage, the clinical manifestation of a SIEDH may develop in a slow way, but once a critical volume of hematoma is reached, the deterioration can become rapid and fatal for acute brain stem compression. Surgery is the mainstay of SIEDHs treatment: among 42 cases with SIEDH included in this review, 40 (95.23%) patients were treated with surgery while only two were managed conservatively. Also in our series, all patients underwent surgery. A combined supratentorial craniotomy and suboccipital craniotomy leaving in a bone bridge over the transverse sinus for dural tenting sutures resulted the most used and safe surgical approach. SIEDH is a rare type of EDH. Early diagnosis of SIEDH and prompt surgical evacuation with a combined supratentorial and suboccipital approach provide excellent recovery.

Keywords

Traumatic extradural hematoma Posterior fossa Supratentorial and suboccipital approach Transverse sinus injury 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The ethical review process and approval by our ethics committee was not required for the present study because it is a retrospective study on patients that required a life-saving intervention. Furthermore, the research data analysis has no effect on the participants and their medical care.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Aji YK, Apriawan T, Bajamal AH (2018) Traumatic supra- and infra-tentorial extradural hematoma: case series and literature review. Asian J Neurosurg 13(2):453–457CrossRefGoogle Scholar
  2. 2.
    Balik V, Lehto H, Hoza D, Sulla I, Hernesniemi J (2010) Posterior fossa extradural haematomas. Cen Eur Neurosurg 71:167–172CrossRefGoogle Scholar
  3. 3.
    Bor-Seng-Shu E, Aguiar PH, de Almeida Leme RJ, Mandel M, Andrade AF, Marino R Jr (2004) Epidural hematomas of the posterior cranial fossa. Neurosurg Focus 16:116–121Google Scholar
  4. 4.
    Bozbuga M, Izgi N, Polat G, Gurel I (1999) Posterior fossa epidural hematomas: observations on a series of 73 cases. Neurosurg Rev 22:34–40CrossRefGoogle Scholar
  5. 5.
    di Somma L, Iacoangeli M, Nasi D, Balercia P, Lupi E, Girotto R et al (2016) Combined supra-transorbital keyhole approach for treatment of delayed intraorbital encephalocele: a minimally invasive approach for an unusual complication of decompressive craniectomy. Surg Neurol Int Suppl 1:S12–S16Google Scholar
  6. 6.
    Dobran M, Mancini F, Nasi D, Scerrati M (2017) A case of deep infection after instrumentation in dorsal spinal surgery: the management with antibiotics and negative wound pressure without removal of fixation. BMJ Case Rep 28:2017Google Scholar
  7. 7.
    Dobran M, Marini A, Gladi M, Nasi D, Colasanti R, Benigni R et al (2017) Deep spinal infection in instrumented spinal surgery: diagnostic factors and therapy. G Chir 38(3):124129CrossRefGoogle Scholar
  8. 8.
    Dobran M, Marini A, Nasi D, Gladi M, Liverotti V, Costanza MD et al (2017) Risk factors of surgical site infections in instrumented spine surgery. Surg Neurol Int 6(8):212CrossRefGoogle Scholar
  9. 9.
    Dobran M, Nasi D, Esposito DP, Iacoangeli M (2016) Posterior fixation with C1 lateral mass screws and C2 pars screws for type II odontoid fracture in the elderly: long-term follow up. World Neurosurg 96:152–158CrossRefGoogle Scholar
  10. 10.
    Iaccarino C, Nicoli D, Gallo C, Nasi D, Pisanello A, De Berti G et al (2010) Analysis of MGMT promoter methylation status on intraoperative fresh tissue section from frameless neuronavigation needle biopsy: a preliminary study of ten patients. Acta Neurochir 152(7):1189–1196CrossRefGoogle Scholar
  11. 11.
    Iaccarino C, Romano A, Ramponi V, Nasi D, Maggi M, Pascarella R et al (2013) Entrapment of temporal horn: first case of bilateral occurrence and review of literature. Clin Neurol Neurosurg 115(10):80 2207–80 2212CrossRefGoogle Scholar
  12. 12.
    Jang JW, Lee JK, Seo BR, Kim SH (2011) Traumatic epidural haematoma of the posterior cranial fossa. Br J Neurosurg 25(1):55–61CrossRefGoogle Scholar
  13. 13.
    Karasu A, Sabanci PA, Izgi N, Imer M, Sencer A, Cansever T, Canbolat A (2008) Traumatic epidural hematomas of the posterior cranial fossa. Surg Neurol 69(3):247–251CrossRefGoogle Scholar
  14. 14.
    Koç RK, Pasaoglu A, Menkü A, Oktem S, Meral M (1998) Extradural hematoma of the posterior cranial fossa. Neurosurg Rev 21:52–57CrossRefGoogle Scholar
  15. 15.
    Nasi D, Dobran M, Di Rienzo A, di Somma L, Gladi M, Moriconi E et al (2018) Decompressive craniectomy for traumatic brain injury: the role of cranioplasty and hydrocephalus on outcome. World Neurosurg 116:e543–e549.  https://doi.org/10.1016/j.wneu.2018.05.028 CrossRefGoogle Scholar
  16. 16.
    Nasi D, Gladi M, Di Rienzo A, di Somma L, Moriconi E, Iacoangeli M et al (2018) Risk factors for post-traumatic hydrocephalus following decompressive craniectomy. Acta Neurochir (Wien). 160(9):1691–1698. doi.  https://doi.org/10.1007/s00701-018-3639-0
  17. 17.
    Nasi D, Iacoangeli M, Dobran M (2018) Response to the letter to the editor: posttraumatic hydrocephalus following decompressive craniectomy—how well it can be predicted? Acta Neurochir.  https://doi.org/10.1007/s00701-018-3688-4
  18. 18.
    Re M, Iacoangeli M, Di Somma L, Alvaro L, Nasi D, Magliulo G, Gioacchini FM, Fradeani D, Scerrati M (2016) Endoscopic endonasal approach to the craniocervical junction: the importance of anterior C1 arch preservation or its reconstruction. Acta Otorhinolaryngol Ital 36(2):107–118Google Scholar
  19. 19.
    Sencer A, Aras Y, Akcakaya MO, Goker B, Kiris T, Canbolat AT (2012) Posterior fossa epidural hematomas in children: clinical experience with 40 cases. J Neurosurg Pediatr 9(2):139–143CrossRefGoogle Scholar
  20. 20.
    Xiaoyu W, Guoping L (2013) Surgical treatment of supra- and infratentorial epidural hematoma. Turk Neurosurg 23:299–303Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Umberto I General HospitalUniversità Politecnica delle MarcheAnconaItaly
  2. 2.Department of Neurosurgery of Institute for Scientific and Care Research “ASMN”Neurosurgery-Neurotraumatology Unit of University Hospital of ParmaReggio EmiliaItaly
  3. 3.Department of NeurosurgeryS. Anna University HospitalFerraraItaly
  4. 4.Department of NeurosurgeryHumanitas University and Research InstituteMilanItaly

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