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Surgery for contralateral acute epidural hematoma following acute subdural hematoma evacuation: five new cases and a short literature review

  • Clinical Article - Brain Injury
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The occurrence of a contralateral acute epidural hematoma (AEDH) following removal of an acute subdural hematoma (ASDH) is a rare but nearly devastating postoperative complication. Here, we describe a series of five patients with contralateral AEDH and provide a review of the literature to elucidate the characteristics and improve management of these patients.


A total of 386 patients underwent ASDH evacuations in our hospital between August 2008 and July 2011. Five of these patients (1.3 %) developed AEDH that required surgery. Thirty-two additional patients were identified by a search of the PubMed database. Clinical features, surgical treatment, and outcomes (scored by Glasgow outcome scale, GOS) of the collective 37 AEDH cases were analyzed retrospectively.


Contralateral AEDH after ASDH evacuation occurred in 27 males (73 %) and 10 females (27 %) (mean age: 35.9 ± 14.2 years). Twenty-six patients (70 %) had unfavorable outcomes (GOS 1–3), and 11 patients (30 %) had favorable outcomes (GOS 4–5). Contralateral skull fractures and intraoperative acute brain swelling occurred in 30 (81 %) and 28 (76 %) patients, respectively. The preoperative Glasgow coma score (GCS) was significantly associated with outcome (p < 0.05).


Lower preoperative GCS score is an independent risk factor for prognosis of contralateral AEDH after ASDH. Postoperative management should include assessment of AEDH in patients treated for contralateral skull fractures and who experienced intraoperative acute brain swelling. We recommend early decompression with a burr-hole craniotomy, immediately followed by a decompressive craniectomy. This strategy provides gradual decompression, while advancing the initial surgical time and preventing the suddle decreased tamponade effect. As such, it may help decrease the risk of contralateral AEDH associated with decompression.

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  1. Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM (2006) Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 104:469–479

    Article  PubMed  Google Scholar 

  2. Borovich B, Braun J, Guilburd JN, Zaaroor M, Michich M, Levy L, Lemberger A, Grushkiewicz I, Feinsod M, Schächter I (1985) Delayed onset of traumatic extradural haematoma. J Neurosurg 63:30–34

    Article  PubMed  CAS  Google Scholar 

  3. Boviatsis EJ, Korfias S, Kouyialis AT, Sakas DE (2004) Epidural haematoma after evacuation of contralateral subdural haematoma. Ir J Med Sci 173:217–218

    Article  PubMed  CAS  Google Scholar 

  4. Chinese Medical Association (2006) Clinical guidelines of Chinese Medical Association: fascicule of neurosurgery. People’s Medical Publishing House, Beijing

    Google Scholar 

  5. Cohen JE, Rajz G, Itshayek E, Umansky F (2004) Bilateral acute epidural haematoma after evacuation of acute subdural haematoma: brain shift and the dynamics of extraaxial collections. Neurol Res 26:763–766

    Article  PubMed  Google Scholar 

  6. Danish SF, Barone D, Barone D, Lega BC, Stein SC (2009) Quality of life after hemicraniectomy for traumatic brain injury in adults. A review of the literature. Neurosurg Focus 26:E2

    Article  PubMed  Google Scholar 

  7. Evans JP, Scheinker IM (1946) Histologic studies of the brain following head trauma; Posttraumatic petechial and massive intraceebral hemorrhage. Neurosurgery 3:101–113

    Article  CAS  Google Scholar 

  8. Feuerman T, Wackym PA, Gade GF, Lanman T, Becker D (1988) Intraoperative development of contralateral epidural haematoma during evacuation of traumatic extraaxial haematoma. Neurosurgery 23:480–484

    Article  PubMed  CAS  Google Scholar 

  9. Guilburd JN, Sviri GE (2001) Role of dural fenestrations in acute subdural hematoma. J Neurosurg 95:263–267

    Article  PubMed  CAS  Google Scholar 

  10. Huang AP, Chen YC, Hu CK, Lin TK, Huang SJ, Tu YK (2011) Intraoperative sonography for detection of contralateral acute epidural or subdural hematoma after decompressive surgery. J Trauma 70:1578–1579

    Article  PubMed  Google Scholar 

  11. Kaufman HH, Moake JL, Olson JD, Miner ME, Ducrt RP, Preusser JL, Gildenberg PL (1980) Delayed and recurrent intracranial hematomas related to disseminated intravascular clotting and fibrinolysis in head injury. Neurosurgery 7:445–449

    Article  PubMed  CAS  Google Scholar 

  12. Koç RK, Akdemir H, Oktem IS, Meral M, Menkü A (1997) Acute subdural hematoma: outcome and outcome prediction. Neurosurg Rev 20:239–244

    Article  PubMed  Google Scholar 

  13. Kontopoulos V, Foroglou N, Patsalas J, Magras J, Foroglou G, Yiannakou-Pephtoulidou M, Sofianos E, Anastassiou H, Tsaoussi G (2002) Decompressive craniectomy for the management of patients with refractory hypertension: should it be reconsidered? Acta Neurochir (Wien) 144:791–796

    Article  CAS  Google Scholar 

  14. Matsuno A, Katayama H, Wada H, Morikawa K, Tanaka K, Tanaka H, Murakami M, Fuke N, Nagashima T (2003) Significance of consecutive bilateral surgeries for patients with acute subdural hematoma who develop contralateral acute epi- or subdural hematoma. Surg Neurol 60:23–30

    Article  PubMed  Google Scholar 

  15. Meguro K, Kobayashi E, Maki Y (1987) Acute brain swelling during evacuation of subdural haematoma caused by delayed contralateral extradural haematoma: report of two cases. Neurosurgery 20:326–328

    Article  PubMed  CAS  Google Scholar 

  16. Mohindra S, Mukherjee KK, Gupta R, Chhabra R, Gupta SK, Khosla VK (2005) Decompressive surgery for acute subdural haematoma leading to contralateral extradural haematoma: a report of two cases and review of literature. Br J Neurosurg 19:490–494

    Article  PubMed  CAS  Google Scholar 

  17. Moon KS, Lee JK, Kim TS, Jung S, Kim JH, Kim SH, Kang SS (2007) Contralateral acute subdural hematoma occurring after removal of calcified chronic subdural hematoma. J Clin Neurosci 14:283–286

    Article  PubMed  Google Scholar 

  18. Piepmeier JM, Wagner FC Jr (1982) Delayed post-traumatic extracerebral haematomas. J Trauma 22:455–460

    Article  PubMed  CAS  Google Scholar 

  19. Ravenel JG, Lieberman KA, Wasenko JJ (2000) Delayed epidural haematoma after evacuation of subdural hematoma. Emerg Radiol 7:111–113

    Article  Google Scholar 

  20. Saberi H, Meybodi AT, Meybodi KT, Habibi Z, Mirsadeghi SM (2009) Delayed post-operative contralateral epidural hematoma in a patient with right-sided acute subdural hematoma: a case report. Cases J 2:6282

    Article  PubMed  Google Scholar 

  21. Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC (1981) Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within 4 h. N Engl J Med 304:1511–1518

    Article  PubMed  CAS  Google Scholar 

  22. Servadei F, Nanni A, Nasi MA, Zappi D, Vergoni G, Giuliani G, Arista A (1995) Evolving brain lesions in the first 12 h after head injury: analysis of 37 comatose patients. Neurosurgery 37:899–907

    Article  PubMed  CAS  Google Scholar 

  23. Stone JL, Lowe RJ, Jonasson O, Baker RJ, Barrett J, Oldershaw JB, Crowell RM, Stein RJ (1986) Acute subdural hematoma: direct admission to a trauma center yields improved results. J Trauma 26:445–450

    Article  PubMed  CAS  Google Scholar 

  24. Su TM, Lee TH, Chen WF, Lee TC, Cheng CH (2008) Contralateral acute epidural hematoma after decompressive surgery of acute subdural hematoma: clinical features and outcome. J Trauma 65:1298–1302

    Article  PubMed  Google Scholar 

  25. Wilberger JE, Harris M, Diamond DL (1991) Acute subdural hematoma: morbidity, mortality, and operative timing. J Neurosurg 74:212–218

    Article  PubMed  Google Scholar 

  26. Yang XF, Wen L, Shen F, Li G, Lou R, Liu WG, Zhan RY (2008) Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien) 150:1241–1248

    Article  CAS  Google Scholar 

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Correspondence to Ren Ya Zhan.

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Shen, J., Pan, J.W., Fan, Z.X. et al. Surgery for contralateral acute epidural hematoma following acute subdural hematoma evacuation: five new cases and a short literature review. Acta Neurochir 155, 335–341 (2013).

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