Epidural Hematoma Evacuation
Imaged above is an epidural hematoma evacuation surgery. An epidural hematoma (EDH) is the traumatic accumulation of blood between the inner layer (or table) of the skull, and the dural membrane.The Dura Mater is the toughest of the meninges (layers protecting the brain) to penetrate due to the interwoven fibrous nature of the membrane. When a force is applied to the head in the correct manner, such as from a hammer or bat, blood vessels proximal to the site of impact may hemorrhage and begin to leak blood. In approximately 85-96% of patients, a skull fracture is also seen. Prognosis is usually optimistic if the injury is treated aggressively. Interestingly, 70-80% of the epidural hematomas that occur are in the tempoparietal region where the skull may fracture proximal to the middle meningeal artery and/or its dural branches. In children, the calvarium is still hardening and skull fractures are less prominent when EDH is present. One third of patients have venous bleeding that is the source of blood leakage, however the majority of patients have arterial bleeding as the source. A neurosurgical team may use burr holes and a drill to remove the portion of the skull that is above the hemorrhage. If a fracture is implicated, careful removal of the bone fragments and management of the perimeter of the skull fracture can occur. The coagulated blood (seen above as a red gel-like substance) can be scraped away with the help of irrigation. Once the blood has been removed, a surgeon can find the localized vessel rupture and cauterize it with a bipolar coagulator. Sometimes surgical mesh is applied over the rupture that will later dissolve; this mesh serves to improve healing and prevent another rupture when the vessel is recovering. The skull can then be replaced and scalp sutured.
