Epidural or extradural hematoma is a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull. The dura mater also covers the spine, so epidural bleeds may also occur in the spinal column. Often due to trauma, the condition is potentially deadly because the buildup of blood may increase pressure in the intracranial space, compress delicate brain tissue, and cause brain shift.
The interior of the skull has sharp ridges by which a moving brain can be injured
The most common cause of intracranial epidural hematoma is traumatic, although spontaneous hemorrhage is known to occur. Hemorrhages commonly result from acceleration-deceleration trauma and transverse forces. The brain may be injured by prominences on the inside of the skull as it scrapes past them. Epidural hematoma is usually found on the same side of the brain that was impacted by the blow, but on very rare occasions it can be due to a contrecoup injury.
As with other types of intracranial hematomas, the blood may be removed surgically to remove the mass and reduce the pressure it puts on the brain. The hematoma is evacuated through a burr hole or craniotomy.
In a craniotomy for epidural hematoma, the patient will be prepared and placed under general anesthesia. The surgeon will make an incision, and pull back the scalp over the area of the hematoma. A drill is used to make a hole in the skull, and a "footplate attachment" on the drill, or another similar device, is used to cut open a flap of skull. The hematoma (blood clot) is now seen, and the surgeon will remove it from the surface of the dura mater (firm covering of the brain). Any visible bleeding points will be cauterized. Often, a bleeding artery is found. The surgeon will then close, and approximate the skull using titanium plates to hold the bone together. Next the scalp will be closed in layers, and a pressure monitor may be placed into the brain to allow the postoperative monitoring of pressure within the brain.
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