Traumatic epidural haematomas of nonarterial origin: analysis of 30 consecutive cases

The purpose was to analyse the clinical and radiological findings, and management approaches used in 30 consecutive cases of traumatic epidural haematoma of nonarterial origin treated at one centre. Medical records for 30 patients surgically treated for epidural haematoma of nonarterial origin betwe...

Full description

Saved in:
Bibliographic Details
Published in:Acta neurochirurgica 2005-12, Vol.147 (12), p.1241-1248
Main Authors: Yilmazlar, S, Kocaeli, H, Dogan, S, Abas, F, Aksoy, K, Korfali, E, Doygun, M
Format: Article
Language:English
Subjects:
Adolescent
Adult
Arachnoid - blood supply
Arachnoid - pathology
Arachnoid - physiopathology
Cerebral Veins - diagnostic imaging
Cerebral Veins - injuries
Cerebral Veins - pathology
Child
Child, Preschool
Cranial Sinuses - diagnostic imaging
Cranial Sinuses - injuries
Cranial Sinuses - pathology
Dura Mater - blood supply
Dura Mater - pathology
Dura Mater - physiopathology
Head Injuries, Closed - complications
Hematoma, Epidural, Cranial - diagnostic imaging
Hematoma, Epidural, Cranial - etiology
Hematoma, Epidural, Cranial - physiopathology
Humans
Infant
Middle Aged
Postoperative Complications - etiology
Postoperative Complications - pathology
Postoperative Complications - physiopathology
Predictive Value of Tests
Secondary Prevention
Sinuses
Skull - blood supply
Skull - immunology
Skull - pathology
Surgery
Tomography, X-Ray Computed
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The purpose was to analyse the clinical and radiological findings, and management approaches used in 30 consecutive cases of traumatic epidural haematoma of nonarterial origin treated at one centre. Medical records for 30 patients surgically treated for epidural haematoma of nonarterial origin between 1997 and 2003 were reviewed. Epidural haematoma of nonarterial origin was diagnosed based on computed tomography (CT) and the bleeding source was confirmed intra-operatively. Admission status, outcome, fracture location, haematoma location/size/volume, and additional intracranial pathology were among the data noted. Two groups were formed for analysis: venous sinus bleeding (group 1) and other venous sources (group 2). The 30 cases accounted for 25% of the total number of traumatic epidural haematomas (n = 120) treated during the same period. The epidural haematomas of nonarterial origin locations were transverse sigmoid sinus (n = 11; 36.7%), superior sagittal sinus (n = 6; 20%), venous lakes (n = 5; 16.6%), diploë (n = 5; 0.16%), arachnoid granulations (n = 2; 6.7%), petrosal sinus (n = 1; 3.3%). There were 12 postoperative complications in 9 patients: recurrence (n = 4; 13.3% of the 30 total), pneumonia (n = 4; 13.3%), meningitis (n = 2; 6.7%), hydrocephalus (n = 1; 3.3%) and subdural effusion (n = 1; 3.3%). All recurrence cases were re-explored. Six (20%) patients died. Glasgow Outcome Scale (GOS) scores (mean follow-up 13.3 +/- 7.8 months) revealed 22 (73.3%) patients with favourable results (GOS 4-5) and 8 (26.7%) had poor results (GOS 1-3). Cases of epidural haematoma of nonarterial origin differ from the more common arterial-origin epidural haematomas with respect to lesion location, surgical planning, postoperative complications, and outcome. Epidural haematoma of nonarterial origin should be suspected if preoperative CT shows a haematoma overlying a dural venous sinus or in the posterior fossa and convexity. The sinus-origin group had a high frequency of fractures which crossed the sinuses, and this might be diagnostically and surgically useful in such cases.
ISSN:0001-6268
0942-0940
DOI:10.1007/s00701-005-0623-2