Endoscopically assisted supratentorial evacuation of infratentorial epidural hematomas crossing the transverse sinus

Abstract

Objective: Traumatic posterior fossa extradural hematoma (TPFEDH) is a serious complication of cranial injury and the orthodox technique for removal of TPFEDH encompasses a suboccipital craniectomy or craniotomy. However, in some cases, the TPFEDH might extend to the supratentorial space, thus appearing to be crossing the transverse sinus. Contrary to the standard way, a modified supratentorial transoccipital approach may be better suitable in the management of this subtype of TPFEDH. Methods: The clinical data of 34 consecutive patients in which the TPFEDH was crossing the transverse sinus were prospectively assessed. We operated all the parents using the supratentorial transoccipital approach via supratentorial liner incision. The supratentorial extradural hematoma (EDH) was evacuated and the endoscope was used to fully evacuate the infratentorial compartment. Glasgow Coma Scale at discharge (dGCS) was documented and Glasgow Outcome Scale score (GOS) was measured at 3–15 months (mean = 5.4 months) follow-up subsequently. Results: The average operation time was 44 min (30–60 min). The blood loss was so minimal that the intraoperative blood transfusion was unnecessary for all the patients. Complete hematoma removal was achieved on all the patients. The average dGCS and GOS were 14 and 4.9 respectively. One case suffered from primary brain stem injury whose GOS scored only 3 on follow up. There was no surgery related mortality at discharge and during the follow-up. Conclusion: This is the first case series to demonstrate the removal of TPFEDH crossing the transverse sinus via the modified supratentorial transoccipital craniotomy. This approach was proven to be more effective in managing such cases. Keywords: TPFEDH, Supratentorial, Infratentorial, Transoccipital, Endoscopy