International Journal of Head and Neck Surgery

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VOLUME 14 , ISSUE 3 ( July-September, 2023 ) > List of Articles

CASE REPORT

Surgical Acute Epidural Hematoma in Temporal Perioral Region of Brain: Case Report

Soobia Saeed, Muhammad B Qasim

Keywords : Extradural, Haematoma, CT, Traumatic brain injury, Retrospective study, life threatening brain compression

Citation Information : Saeed S, Qasim MB. Surgical Acute Epidural Hematoma in Temporal Perioral Region of Brain: Case Report. Int J Head Neck Surg 2023; 14 (3):54-58.

DOI: 10.5005/jp-journals-10001-1552

License: CC BY-NC 4.0

Published Online: 10-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: There is an inconsistent number of road traffic accidents occurring in developing countries, which are a major cause of epidural hematomas, which are usually life-threatening brain compressions that require emergency surgical evacuation. Epidural hematoma is a common sequela of traumatic brain injury (TBI). This case presents an EDH in the temporal-perioral region of a 25-year-old young boy with a traumatic brain injury. A follow-up computed tomography (CT) showed that EDH had manifested on the left side of the brain after being transferred to our hospital with unconsciousness status. The EDH is characterized by a variable clinical presentation in acute situations. In most cases, extradural hematomas are caused by injury to the middle meningeal artery or its branches caused by direct trauma to the temporal bones of the skull. An extradural hematoma in the posterior cranial fossa occurred following a skull fracture in the tempo-perioral region. An injury to the brainstem that is not recognized may cause a rapid respiratory arrest due to brainstem compression if the bleeding is ignored. An attending clinician should be alerted to the possibility of this uncommon but potentially fatal condition in the presence of significant occiput trauma. Methods: To reduce pressure and drain blood outside, the patient may require a small incision to be drilled in the skull. To remove big hematomas or solid blood clots, an additional incision in the head (craniotomy) may be required. A stereotaxic head CT was used to confirm the locations and volumes of the bleeding before surgery. The angle and depth of the puncture were assessed, and it was found that the largest hematoma region was at the scalp puncture location. A manual skull driller was used to drill the skull and scalp, and a brain puncture needle was used to aspirate the hematoma as much as possible. Drainage tube 10F is placed into the hematoma cavity, the tube core is removed, and drainage tube 1 cm is then placed into the hematoma cavity. After tube suturing and fastening, a closed backflow prevention drainage device was installed. The hematoma was fixed by the neurosurgeons using hemostress skewered with a bipolar device and sponge placement. The following phase involved placing 30 vicryles to secure the dura and draining the area. The brain's skin was closed with 2.0 silk, and the Subtanous layers were sealed off with 2.0 velvet. Result: The operation took between 15 and 30 minutes to complete. After the hematoma was rinsed with normal saline, the neurosurgeon injected 20,000–40,000 units of urokinase into the hematoma cavity with normal saline (2–3 mL, depending on the size of the hematoma). After thorough surgery and regular checkups to monitor the epidural hematoma, the patient was discharged with no neurological impairments. Conclusion: The neurosurgeon performed surgery immediately within two hours due30 mL to a single minimally invasive hematoma and removed the hematoma. The hematoma volume WmL, 80 mL and it was significantly reduced to around 30mL. The acute epidural hematoma was drained with the use of a drainage tube, which resolved the acute hematoma.


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