CHRONIC VENOUS EPIDURAL HEMATOMA AT THE VERTEX.

Abstract

The fact that epidural hemorrhage constitutes an immediate threat to life has been accepted since the early reports of Hill al (1773) and of Cock la (1843). Callender, 7 in 1867, wrote that all treatment of epidural hemorrhage was hopeless and advised against futile trephination of the skull. Gross 2a (1873), however, basing his opinion on his experiences during the Battle of Shiloh on April 6, 1863, urged immediate evacuation of extradural hematomas by trephination. Gross, and later Erichsen 17 in 1878, believed that this epidural bleeding was of venous origin. Jacobson 3s (1886), while agreeing with Gross on treatment, suggested an arterial origin of these hematomas in his classical treatise. In 1913, the anatomist, Jones, 39 demonstrated that the grooves in the inner table of the parietal bones are formed by the middle meningeal veins or sinuses, not by arteries. His studies at necropsy of 3 cases of epidural hemorrhage revealed lacerations of these veins; the middle meningeal arteries were not injured. 4~ Vance, 73 during his tenure as medical examiner of New York City, compiled a list of an impressive number of epidural hematomas which included examples of lacerations of the venous sinus. Rowbotham 6~ considered bleeding from diploic veins as the most frequent cause of epidural hemorrhage. Ver Brugghen, TM Reichert and Morrissey, 64 Gurdjian and Webster, 25 King and Chambers ~ and others n,17,1s'34'42,s~ also have emphasized the various venous sources of epidural bleeding. The literature contains several reports of intracranial hemorrhage following laceration of the superior sagittal, straight and transverse venous sinuses. 6,t~176 Subsequent to the beautifully illustrated and documented papers of Wharton 77 and Holmes and Sargent 32 dealing with injuries to the superior sagittal sinus, Gurdjian and Webster 24 collected all existing reports of extradural hematomas after injury of the dural sinus. The first report of an epidural hematoma that compressed the superior sagittal sinus was that which occurred in a d r a g o o n . . . wounded at the battle of Salamanca by a musket-ball in the body, which caused him to fall from his horse, injuring the top of his head. ''27 Operative findings of epidural hematomas that have stripped the superior sagittal sinus from the inner table of the skull