Intraoperative contralateral extradural hematoma during evacuation of traumatic acute extradural hematoma

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Abstract

Introduction: Extradural hematomas (EDHs) accounts for approximately 2% of patients following head trauma and 5-15% of patients with fatal head injuries. When indicated, the standard surgical management consists of evacuation of the hematoma via craniotomy. Intraoperative development of acute extradural hematoma (AEDH) on the contralateral side following evacuation of acute extradural hematoma is uncommon and very few cases have been reported.

Case report: We report a case of 28 year-old-male who suffered from a severe head injury following assault and diagnosed as acute extradural hematoma over right fronto-parietal region with midline shift towards left. Patient underwent emergency craniotomy with acute EDH evacuation. Following evacuation of acute EDH the duramater was tense which was unusual finding. With anticipation of underling acute SDH small durotomy was done, but there were no sub dural hematoma. Bone flap were repositioned and closure were done. Patient was shifted for NCCT head from OT, which revealed 2.7cm acute EDH over left frantoparietal region. Patient was again shifted back to OT and left frontoparietal craniotomy with evacuation of hematoma was done. Postoperative NCCT head was satisfactory. However, the patient remained severely disabled.

Conclusion: Formation of contralateral EDH after AEDH surgery is a rare but potentially dangerous complication. A high degree of suspicion should be kept for contralateral extradural hematoma if during surgery there is tense duramater following AEDH evacuation. We would advise urgent NCCT head especially if a fracture is demonstrated on the preoperative CT scan on contralateral side. This would save some invaluable time, which may help in changing the outcome in some of the patients.

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Romanian Neurosurgery

The Journal of Romanian Society of Neurosurgery

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