Postoperative Extradural Hematomas Angelo Pichierri 1 Andrea Ruggeri 1 Pasquale Donnarumma 1 Roberto Delfini 1 1 Division of Neurosurgery, Department of Neurological Sciences, “Sapienza” Univsersity of Rome, Rome, Italy J Neurol Surg A 2013;74:25–28. Address for correspondence and reprint requests Angelo Pichierri, MD, PhD, Division of Neurosurgery, Department of Neurological Sciences, “Sapienza” Univsersity of Rome, V.le del Policlinico 155, Rome, Italy 00156 (e-mail: angelopichierri@gmail.com). Introduction Extradural hematoma is usually associated with previous head trauma; however, it may occur as a result of head surgery (postoperative extradural hematoma, POEH) in a small percentage of cases ranging from 0.8 to 1.3%. 1–5 POEH is a neglected though described entity 6–8 : it can (though not always) be partially prevented by some well-known technical steps. 5,9,10 Nevertheless, a consistent discussion about the features and management of POEH is lacking. We report our series of POEH occurring within 24 hours after craniotomy. Materials and Methods A total of 1500 patients treated with craniotomy from 2004 to 2011 by a single surgeon were examined. Of these, 853 were elective and 647 were emergency surgeries (►Table 1). Elective patients under acetylsalicylic acid treatment under- went surgery after 5 days from drug suspension. 11 Elective patients treated with oral anticoagulant or affected by coagulopathy were operated after international normalized ratio (INR) normalization. 11 Emergency cases were treated regardless of blood coagulation status, normalizing the values during the operation. 7 Hemostatic and closing surgical procedures were the same for all patients: dural tack-up sutures and central tenting sutures were made in every case. The craniotomy area ranged from 30 to 100 cm 2 (mean size 65 cm 2 ). We defined POEH on the basis of the postoperative com- puted tomography (CT) scan. The ABC/2 technique was applied to hematoma volume measurement. 12 Patients were clinically evaluated to identify a possible correlation between neurolog- ical status and the presence of the clot, which could drive our decision whether to evacuate or watch the hematoma. Results Thirteen patients had a POEH. Of these, nobody was under previous acetylsalicylic acid, clopidogrel or oral anticoagulant treatments; clinical history of all the patients was negative for any known coagulopathies. Five of these patients (0.3% of the entire population, N ¼ 1500) needed operation for evacua- tion. They were all affected by extradural hematomas >40 cc, with typical CT features and overt clinical picture. Eight patients (0.5%) showed variable clinical status (►Table 2) and extradural hematomas <40 cc with atypical CT findings (i.e., different from traumatic and spontaneous extradural hematomas): Keywords ► postoperative extradural hematoma ► iatrogenic extradural hematoma ► complications ► neurosurgery Abstract Postoperative extradural hematoma (POEH) is a possible complication after head surgery, often neglected in the literature. In a single surgeon experience we found 13 cases of POEH (0.8%). We distinguished two subtypes: (1) larger hematomas (>40 cc) with typical features and overt clinical picture that always needed evacuation, and (2) smaller hematomas (<40 cc) with insidious clinical onset and different radiological features compared with traumatic and spontaneous extradural hemato- mas. On the basis of our experience, we propose that clinical picture and radiologic appearance lead the decision between conservative or interventional treatment of type II hematomas. received January 25, 2012 accepted after revision July 1, 2012 published online November 8, 2012 © 2013 Georg Thieme Verlag KG Stuttgart · New York DOI http://dx.doi.org/ 10.1055/s-0032-1326939. ISSN 2193-6315. Original Article 25 Downloaded by: IP-Proxy Università La Sapienza, Università La Sapienza. Copyrighted material.