EPIDURAL HEMATOMA AT THE MIDLINE AND VERT EX - CLINICAL SYMPTOMS AND OPERATIVE TREATMENT

Within a group of 315 epidural haematomas treated surgically 8 (2.5%) were located within the midline or at the vertex. The clinical symptom s may be small in frontally located haematomas. Paraparesis is caused by a haematoma localized at the vertex. The latter may be misinterpret ed as a spinal trauma. The recognition of the hyperdense blood within the last slices of normal CT scans needs experience. It has been misin terpreted as hyperostosis of the skull. We present a group of eight pe rsonal cases. The sagittal skull suture was fractured in seven patient s. One patient already had an 11-month history. Four cases were primar y and had not been recognized. The prognosis depends on concomitant pr imary brain injuries. Early diagnosis with operative treatment give th e best chance. Polytraumatized patients with concomitant injuries die. Slowly developing haematomas do not require acute surgery by in exper ienced surgeons. Sagittal sinus laceration must be treated by experien ced neurosurgeons. It can be closed by suturing the dura to the bone w ith implanted collagen. In subacute cases the stiffness of the dura al lows no normalization of the dura position. A dural graft is necessary for repositioning.