Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 14, 2022; 10(2): 477-484
Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.477
Modified surgical method of supra- and infratentorial epidural hematoma and the related anatomical study of the squamous part of the occipital bone
Rui-Chun Li, Shi-Wen Guo, Chen Liang
Rui-Chun Li, Shi-Wen Guo, Chen Liang, Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Liang C conceived and designed the study; Data collection and analysis were performed by Li RC, Guo SW and Liang C; The first draft of the manuscript was written by Li R, and all the authors commented on previous versions of the manuscript; all the authors read and approved the final manuscript.
Supported by Key Research and Development Plan of Shaanxi Province, China, No. 2021SF-298, and No. 2018SF-137.
Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University (KYLLSL-2014-129-01).
Informed consent statement: This study is a retrospective study, and the patient is anonymous, so the patient's informed consent is not necessary.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chen Liang, MD, Doctor, Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an 710061, Shaanxi Province, China. liangchen01@xjtu.edu.cn
Received: July 21, 2021
Peer-review started: July 21, 2021
First decision: October 16, 2021
Revised: October 22, 2021
Accepted: December 10, 2021
Article in press: December 10, 2021
Published online: January 14, 2022
Abstract
BACKGROUND

Supra- and infratentorial acute epidural hematoma (SIEDH) is a common posterior cranial fossa epidural hematoma located at the inner surface of the squamous part of the occipital bone (SOB). Traditionally, surgical treatment of the SIEDH requires a combined supra-infratentorial craniotomy.

AIM

To analyze the morphological characteristics of the SOB and introduce a single supratentorial craniotomy for SIEDH.

METHODS

Skull computed tomography (CT) scan data from 32 adult patients were collected from January 1, 2019 to January 31, 2020. On the median sagittal plane of the CT scan, the angle of the SOB (ASOB) was defined by two lines: Line A was defined from the lambdoid suture (LambS) to the external occipital protuberance (EOP), while line B was defined from the EOP to the posterior edge of the foramen magnum (poFM). The operative angle for the SIEDH (OAS) from the supra- to infratentorial epidural space was determined by two lines: The first line passes from the midpoint between the EOP and the LambS to the poFM, while the second line passes from the EOP to the poFM. The ASOB and OAS were measured and analyzed.

RESULTS

Based on the anatomical study, a single supratentorial craniotomy was performed in 8 patients with SIEDH. The procedure and the results of the modified surgical method were demonstrated in detail. For males, the ASOB was 118.4 ± 4.7 and the OAS was 15.1 ± 1.8; for females, the ASOB was 130.4 ± 5.1 and the OAS was 12.8 ± 2.0. There were significant differences between males and females both in ASOB and OAS. The smaller the ASOB was, the larger the OAS was. The bone flaps in 8 patients were designed above the transverse sinus intraoperatively, and the SIEDH was completely removed without suboccipital craniotomy. The SOB does not present as a single straight plane but bends at an angle around the EOP and the superior nuchal lines. The OAS was negatively correlated with the ASOB.

CONCLUSION

The single supratentorial craniotomy for SIEDH is reliable and effective.

Keywords: Epidural hematoma, External occipital protuberance, Occipital bone, Transverse sinus, Supra- and infratentorial acute epidural hematoma, Modified surgical method

Core Tip: Traditionally, surgical treatment of a supra- and infratentorial acute epidural hematoma (SIEDH) requires a combined supra-infratentorial craniotomy. We analyzed the morphological characteristics of the squamous part of the occipital bone (SOB) and found that the operative angle for the SIEDH was negatively correlated with the angle of the SOB. These morphological characteristics of the SOB make it possible to treat SIEDH with a single supratentorial craniotomy. Based on the above findings, we used a single supratentorial craniotomy to treat SIEDH, and achieved satisfactory results.