Traumatic Frontal Epidural Hematoma Caused by Multiple Arterial Injuries in the Anterior Fossa

详细信息    查看全文

• 作者：J. Willis Kiessling IV¹ ; Dean A. Hertzler II² ; David E.M. Drucker³ ; Heather S. Spader² ; ^{hspader@mhs.net}
• 关键词：Anterior fossa ; Epidural ; Ethmoid artery ; Pediatric
• 刊名：World Neurosurgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：97
• 期：Complete
• 页码：757.e19-757.e23
• 全文大小：802 K
• 卷排序：97

文摘

This case report illustrates the need to evaluate the possibility of multiple arterial sources when presented with a frontal epidural hematoma associated with facial trauma.Case DescriptionThe patient presented after being struck in the face by a baseball. Computed tomography of the brain revealed a large frontal epidural hematoma. Intraoperatively, bleeding from a frontal branch of the middle meningeal artery was encountered and cauterized, and the hematoma was removed. Routine follow-up imaging performed the next day showed a residual frontal hematoma; however, the epidural hematoma was in a more medial location than the initial hematoma. The patient was taken back to the operating room; after frontal lobe retraction and extensive exploration, a different source of bleeding from posterior ethmoidal artery feeders was encountered. After the second operation, the patient's hematoma did not recur, and he was discharged home with no neurologic deficits 3 days later.ConclusionsWe report a case of an epidural hematoma caused by 2 distinct arterial feeders. We discuss radiologic review and operative management of anterior fossa epidural hematomas and stress the importance of considering arterial bleeding from sources other than the middle meningeal artery in anterior fossa epidural hematomas. We discuss the utility of preoperative angiography for these patients and reinforce the need for acute postoperative imaging to ensure successful operative and patient outcomes.