Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.477
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
Processing time: 175 Days and 1.6 Hours
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.
To analyze the morphological characteristics of the SOB and introduce a single supratentorial craniotomy for SIEDH.
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.
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.
The single supratentorial craniotomy for SIEDH is reliable and effective.
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.