Vertex Epidural Hematoma (VEDH): Review Article and Experience of One-Piece Central Craniotomy for Evacuation
Fawaz Eljili, MRCS, MSc, MPH1*, Ahmed Zaidan, MD2, Mohammed Mustafa, MD3 and Honida Ali, MD4
1Registrar of neurosurgery, Al tamyouz (haj almardi) trauma center, Khartoum, Sudan.
2Neurosurgeon, Al tamyouz (haj almardi) trauma center, Khartoum, Sudan.
3Registrar of neurosurgery, National center for neurological sciences (NCNS), Khartoum, Sudan.
4Neurosurgeon, Neurospine center, Ribat university hospital, Khartoum, Sudan.
*Corresponding Author: Dr. Fawaz Eljili, MRCS, MSc, MPH Registrar of neurosurgery, Al tamyouz (haj almardi) trauma center, Khartoum, Sudan.
Received: August 24, 2022 Published: September 10, 2022
Abstract
Introduction: Vertex EDH is rare type of EDH found in the highest skull vault and account for 0.024% of all head injuries and 0.47-8.20% of all intracranial extradural hematomas. Some cases of VEDHs extended beyond the anatomical area of the vertex. It is commonly caused by linear crossing skull fracture over the sinus caused by direct insult to the vertex or diastasis of the sagittal suture. VEDH presentation is usually atypical with non-specific symptoms and signs, and can be presented as acute, subacute or chronic. VEDH radiological feature and diagnosis is considered challenging and this is explained by its higher location in the skull vault. Ct brain with coronal cut is the best or sometimes may MRI be requested.
Method: This a review article done through the engine search PubMed and google scholar, using the key words and terms (vertex), (epidural) or (extradural hematoma) presentation, management or surgical technique, case report, case series or other relevant reviews are revised for the relevant information for our title without specification to period of time.
Our department experience and technique: Five cases out of 115 case of EDH (4.34%) were diagnosed as VEDH during the period of June 2019-june 2020. All five cases were operated through central vertex craniotomy with one bone flap including the bone over the sinus unlike the way that mentioned in the literature by doing biparietal separate parasagittal craniotomy with central bone strip left in place over the sinus.
Reviewed articles critique: Discomfort during the evacuation and difficultly to conduct direct sinus repair in case of significant tear when using the mentioned approach in the literature. Addition to that the risk of injury of the important draining veins during dural tack up.
Conclusion: Vertex EDH is a rare type of EDH but challenging in both diagnosis and surgical treatment. In the literature the commonly used approach for surgery was biparietal parasagittal craniotomy. We add our department approach and experience through one-piece craniotomy without leaving central bone strip. It was a comparison between each regarding the advantages and disadvantages. We encourage to utilize this approach craniotomy and report any advantages or disadvantages may have encountered to the literature.
Keywords: Vertex EDH, Central Craniotomy, extradural hematoma
Citation: Eljili F, Zaidan A, Mustafa M, Ali H. “Vertex Epidural Hematoma (VEDH): Review Article and Experience of One-Piece Central Craniotomy for Evacuation”. SVOA Neurology 2022, 3:5, 168-175.
