Extradural Hemorrhage

Abstract

(The classical epidural hematoma due to arterial bleeding from the middle meningeal artery and its branches.) This disorder does not present any technical difficulties as long as the operation is done early, before the expanding hematoma has ripped the dura from the inner table over a wide enough area which, in turn, adds to the arterial, emmissary venous, and dural sinus bleeding. If definitive care is delayed and if the patient is still living, the operation becomes formidable and will require a wide craniotomy done with speed and the dura must be tented in many places to the pericranium, to the bone, or even to the galea. Therefore, if there is any early suspicion about the presence of expanding epidural hematoma, it is better not to hesitate in doing bilateral low temporal burr holes. These two burr holes will do no harm to the patient and the time spent in doing an angiographic study may be wasteful. The statements made here are directed to the general surgeon who, in our experience, is the one who primarily sees these patients. It is true that there are epidural hemorrhages which have developed over days, but these are the exception.