Large vertex epidural hematoma: case report and review of surgical approaches
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFRN |
Texto Completo: | https://repositorio.ufrn.br/handle/123456789/52364 |
Resumo: | Vertex epidural hematomas (VEHs) are a special clinical entity due to their clinical presentation, vascular etiology and options of surgical approach. The clinical suspicion involves recognizing the mechanism of the injury and the correct visualization of the hematoma in computed tomography (CT) coronal sequences. In the present article, we describe a case of a very large (146 mL) VEH with central brain herniation, and provide a technical note on the surgical planning and treatment. A 34-year-old male patient was admitted to the hospital after an injury on the left superior parietal region. The Glasgow coma scale score was 6, and the left pupil of the patient was dilated. The CT scan showed a large epidural hematoma on the vertex between the coronal e lambdoid sutures, and a fracture over the sagittal suture. During the surgery, multiple burr holes were made laterally to the sagittal suture, and after inspection and no visualization of bleeding in the superior sagittal sinus (SSS), we performed a standard biparietal craniotomy. The patient was discharged three days after the surgery without any deficits. Currently, with the improvement in imaging modalities, more cases of VEH are being identified. Identifying the etiology prior to the craniotomy is challenging in severe cases. Tears in the SSS can bleed profusely, and they demand strategies during the craniotomy. With multiple burr holes parallel to the sagittal suture, we can visualize whether there is bleeding in the SSS and design a craniotomy with or without a central osseous bridge to anchor the dura. Neurosurgeons must be prepared to plan a surgical strategy in cases of large VEHs. Due to its rare frequency and bleeding risks, VEHs are considered challenging. |
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Silva Neto, Angelo R.Medeiros, LuanaSilva, Fábio B.Velloso, Renata N.0000-0002-3819-89512023-05-12T21:36:39Z2023-05-12T21:36:39Z2019-07-01SILVA NETO, Angelo R.; URUGUAY, Ana Luíza R.; PAIVA, Damácio S.; SILVA, Alice L.P.; GODEIRO, Arthur H.M.; EBERLIN, Letícia M.N.. Neurogenic Bladder Dysfunction as Signal of Late Failure of Endoscopic Third Ventriculostomy in Child with Spina Bifida. World Neurosurgery, [S.L.], v. 128, p. 454-457, ago. 2019. Elsevier BV. http://dx.doi.org/10.1016/j.wneu.2019.05.138.https://repositorio.ufrn.br/handle/123456789/5236410.1055/s-0039-1695760.ElsevierAtribuição 3.0 Brasilhttps://creativecommons.org/licenses/by-nc-nd/4.0/deed.pt_BRinfo:eu-repo/semantics/openAccessvertex epidural hematomatraumatic brain injurycraniotomyLarge vertex epidural hematoma: case report and review of surgical approachesinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleVertex epidural hematomas (VEHs) are a special clinical entity due to their clinical presentation, vascular etiology and options of surgical approach. The clinical suspicion involves recognizing the mechanism of the injury and the correct visualization of the hematoma in computed tomography (CT) coronal sequences. In the present article, we describe a case of a very large (146 mL) VEH with central brain herniation, and provide a technical note on the surgical planning and treatment. A 34-year-old male patient was admitted to the hospital after an injury on the left superior parietal region. The Glasgow coma scale score was 6, and the left pupil of the patient was dilated. The CT scan showed a large epidural hematoma on the vertex between the coronal e lambdoid sutures, and a fracture over the sagittal suture. During the surgery, multiple burr holes were made laterally to the sagittal suture, and after inspection and no visualization of bleeding in the superior sagittal sinus (SSS), we performed a standard biparietal craniotomy. The patient was discharged three days after the surgery without any deficits. Currently, with the improvement in imaging modalities, more cases of VEH are being identified. Identifying the etiology prior to the craniotomy is challenging in severe cases. Tears in the SSS can bleed profusely, and they demand strategies during the craniotomy. With multiple burr holes parallel to the sagittal suture, we can visualize whether there is bleeding in the SSS and design a craniotomy with or without a central osseous bridge to anchor the dura. Neurosurgeons must be prepared to plan a surgical strategy in cases of large VEHs. Due to its rare frequency and bleeding risks, VEHs are considered challenging.engreponame:Repositório Institucional da UFRNinstname:Universidade Federal do Rio Grande do Norte (UFRN)instacron:UFRNCC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8914https://repositorio.ufrn.br/bitstream/123456789/52364/2/license_rdf4d2950bda3d176f570a9f8b328dfbbefMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-81484https://repositorio.ufrn.br/bitstream/123456789/52364/3/license.txte9597aa2854d128fd968be5edc8a28d9MD53ORIGINALLargeVertexEpidural_SilvaNeto_2019.pdfLargeVertexEpidural_SilvaNeto_2019.pdfapplication/pdf230615https://repositorio.ufrn.br/bitstream/123456789/52364/1/LargeVertexEpidural_SilvaNeto_2019.pdffdaefc81b1ee465fa4175134b394d352MD51123456789/523642023-07-04 13:50:59.769oai:https://repositorio.ufrn.br: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Repositório de PublicaçõesPUBhttp://repositorio.ufrn.br/oai/opendoar:2023-07-04T16:50:59Repositório Institucional da UFRN - Universidade Federal do Rio Grande do Norte (UFRN)false |
dc.title.pt_BR.fl_str_mv |
Large vertex epidural hematoma: case report and review of surgical approaches |
title |
Large vertex epidural hematoma: case report and review of surgical approaches |
spellingShingle |
Large vertex epidural hematoma: case report and review of surgical approaches Silva Neto, Angelo R. vertex epidural hematoma traumatic brain injury craniotomy |
title_short |
Large vertex epidural hematoma: case report and review of surgical approaches |
title_full |
Large vertex epidural hematoma: case report and review of surgical approaches |
title_fullStr |
Large vertex epidural hematoma: case report and review of surgical approaches |
title_full_unstemmed |
Large vertex epidural hematoma: case report and review of surgical approaches |
title_sort |
Large vertex epidural hematoma: case report and review of surgical approaches |
author |
Silva Neto, Angelo R. |
author_facet |
Silva Neto, Angelo R. Medeiros, Luana Silva, Fábio B. Velloso, Renata N. |
author_role |
author |
author2 |
Medeiros, Luana Silva, Fábio B. Velloso, Renata N. |
author2_role |
author author author |
dc.contributor.authorID.pt_BR.fl_str_mv |
0000-0002-3819-8951 |
dc.contributor.author.fl_str_mv |
Silva Neto, Angelo R. Medeiros, Luana Silva, Fábio B. Velloso, Renata N. |
dc.subject.por.fl_str_mv |
vertex epidural hematoma traumatic brain injury craniotomy |
topic |
vertex epidural hematoma traumatic brain injury craniotomy |
description |
Vertex epidural hematomas (VEHs) are a special clinical entity due to their clinical presentation, vascular etiology and options of surgical approach. The clinical suspicion involves recognizing the mechanism of the injury and the correct visualization of the hematoma in computed tomography (CT) coronal sequences. In the present article, we describe a case of a very large (146 mL) VEH with central brain herniation, and provide a technical note on the surgical planning and treatment. A 34-year-old male patient was admitted to the hospital after an injury on the left superior parietal region. The Glasgow coma scale score was 6, and the left pupil of the patient was dilated. The CT scan showed a large epidural hematoma on the vertex between the coronal e lambdoid sutures, and a fracture over the sagittal suture. During the surgery, multiple burr holes were made laterally to the sagittal suture, and after inspection and no visualization of bleeding in the superior sagittal sinus (SSS), we performed a standard biparietal craniotomy. The patient was discharged three days after the surgery without any deficits. Currently, with the improvement in imaging modalities, more cases of VEH are being identified. Identifying the etiology prior to the craniotomy is challenging in severe cases. Tears in the SSS can bleed profusely, and they demand strategies during the craniotomy. With multiple burr holes parallel to the sagittal suture, we can visualize whether there is bleeding in the SSS and design a craniotomy with or without a central osseous bridge to anchor the dura. Neurosurgeons must be prepared to plan a surgical strategy in cases of large VEHs. Due to its rare frequency and bleeding risks, VEHs are considered challenging. |
publishDate |
2019 |
dc.date.issued.fl_str_mv |
2019-07-01 |
dc.date.accessioned.fl_str_mv |
2023-05-12T21:36:39Z |
dc.date.available.fl_str_mv |
2023-05-12T21:36:39Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
SILVA NETO, Angelo R.; URUGUAY, Ana Luíza R.; PAIVA, Damácio S.; SILVA, Alice L.P.; GODEIRO, Arthur H.M.; EBERLIN, Letícia M.N.. Neurogenic Bladder Dysfunction as Signal of Late Failure of Endoscopic Third Ventriculostomy in Child with Spina Bifida. World Neurosurgery, [S.L.], v. 128, p. 454-457, ago. 2019. Elsevier BV. http://dx.doi.org/10.1016/j.wneu.2019.05.138. |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufrn.br/handle/123456789/52364 |
dc.identifier.doi.none.fl_str_mv |
10.1055/s-0039-1695760. |
identifier_str_mv |
SILVA NETO, Angelo R.; URUGUAY, Ana Luíza R.; PAIVA, Damácio S.; SILVA, Alice L.P.; GODEIRO, Arthur H.M.; EBERLIN, Letícia M.N.. Neurogenic Bladder Dysfunction as Signal of Late Failure of Endoscopic Third Ventriculostomy in Child with Spina Bifida. World Neurosurgery, [S.L.], v. 128, p. 454-457, ago. 2019. Elsevier BV. http://dx.doi.org/10.1016/j.wneu.2019.05.138. 10.1055/s-0039-1695760. |
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https://repositorio.ufrn.br/handle/123456789/52364 |
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eng |
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eng |
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Atribuição 3.0 Brasil https://creativecommons.org/licenses/by-nc-nd/4.0/deed.pt_BR info:eu-repo/semantics/openAccess |
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Atribuição 3.0 Brasil https://creativecommons.org/licenses/by-nc-nd/4.0/deed.pt_BR |
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Elsevier |
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