Surgical strategies for epidural hematoma straddling the transverse sinus: clinical analysis of 58 cases

Abstract

Objective To analyze the clinical management, surgical indications and surgical approaches for epidural hematoma straddling the transverse sinus. Methods The clinical data were collected from 58 patients with epidural hematoma straddling the transverse sinus treated between September, 2001 and December, 2007. Of these patients, the hematoma was found by the initial head CT scan in 42 cases; 10 patients had delayed hematoma, and 6 showed delayed hematoma during craniotomy. All the patients were scanned using 16-slice spiral CT for coronal and sagittal three-dimensional reconstruction, and the total hematoma volume and the supratentorial and infratentorial hematoma volumes were calculated. Forty-two patients were found to have the straddling hematoma volume no less than 30 mL or infratentorial hematoma volume over 15 mL. According to the extension of the hemotoma, a bone flap spanning the transverse sinus was taken, and after hematoma removal, the bone flap was reduced and fixed with cranial screws. In 8 patients with other hematomas or severe intracranial hypertension, routine removal of the hematoma or decompressive craniectomy was performed. Results Fifty-four of the patients recovered, 3 were capable of independent living, and 1 sustained severe disabilities after the operations. No death occurred in these patients. Conclusion In patients with epidural hematoma straddling the transverse sinus, conservative treatment can be administered in cases with the straddling hematoma volume < 30 mL or infratentorial hematoma volume < 15 mL, otherwise timely surgical interventions should be performed. One-step preparation of the bone flap spanning the transverse sinus is safe but secure internal fixation is necessitated after reduction of the bone flap. Key words: Transverse sinus; Hematoma, epidural, cranial; Surgical precedures, operative