intracranial epidural hematoma evacuation

Epidural hematoma is more common, accounting for 3% to 6% of brain injury. About one-third of intracranial hematoma is an epidural hematoma. Although such hematoma can occur at any age, it is more common in 15 to 30 years old, and it is rare in children. The source of bleeding is: 1 middle meningeal artery. Most common. After the artery enters the skull through the spine, it travels along the middle meningeal groove of the inner plate of the skull, and is divided into two branches before and after the wing point, and each branch can be torn to form a hematoma. Especially in the past, it is more common. 2 superior sagittal sinus or transverse sinus. When the fracture line passes through the sinus, it can cause damage and form a hematoma. 3 meninges in the meninges. This vein is accompanied by the middle meningeal artery, which can cause hematoma after injury, but it is rare. 4 plate vein or blood vessel. In the skull barrier, there are reticular barrier veins and blood vessels that penetrate the skull. After the injury, hemorrhage can flow along the fracture line to the epidural to form a hematoma. 5 anterior meningeal artery and anterior and posterior anterior artery. Injuries can occur when the anterior cranial fossa is fractured, but it is rare. The location of the hematoma varies depending on the location of the vascular injury. The main artery of the meningeal is damaged, the hematoma is mostly in the ankle, and can be extended to the forehead or top; the anterior branch is damaged, the hematoma is mostly at the top of the forehead; the hemorrhage of the posterior branch is mostly at the top of the iliac crest. Less common superior sagittal sinus injury, hematoma can be located in the unilateral sagittal sinus, can also occur on both sides of the sinus; transverse sinus injury, hematoma mostly located in the posterior cranial fossa, can also occur in the occipital region, where occurs in Both sides of the superior sagittal sinus or the upper and lower sinus are called straddle hematoma. If you do not pay attention during surgery, it is easy to miss a hematoma. The hematoma formed by the anterior cerebral artery or the anterior and posterior arteries is The frontal or cranial anterior fossa. Epidural hematoma, the majority of single-shot, a few have occurred in both sides, there are also reports of late-onset. Simple epidural hematoma generally has less brain damage. If it can be treated in time, the prognosis is good when the brain is relieved early. Treatment of diseases: chronic epidural hematoma acute epidural hematoma Indication 1. There is a clear intermediate awake period after injury, there is a fracture line through the vascular sulcus, and there are obvious symptoms of brain compression or hook-back syndrome. 2. CT or cerebral angiography, there is a large fusiform hematoma outside the dura mater, and there is a mass effect, so that the midline shift. 3. Those who were confirmed to have an epidural hematoma by drilling. Contraindications 1. Both sides of the pupil dilated, spontaneous breathing has stopped more than 1h, in a state of sudden death. 2. CT examination shows that the amount of hematoma is small, and there is no space-occupying effect. If the patient is in good general condition, conservative treatment can be performed first and closely observed. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. In recent years, due to advances in imaging inspection technology, clinical applications such as CT, MRI, and DSA have become increasingly widespread. The relationship between the location of the lesion and the surrounding structure should be analyzed before surgery in order to select the appropriate surgical approach, to obtain the best exposure, avoid the important structure of the skull as much as possible, increase the safety of the operation and strive for good Effect. 2. Prepare the skin, wash your head with soap and water before surgery, and shave your hair. 3. Fasting before surgery. 4. Give phenobarbital 0.1g, atropine 0.4mg or scopolamine 0.3mg intramuscularly 1h before surgery. Surgical procedure 1. The size of the flap depends on the size of the hematoma. The shape of the incision is based on the general craniotomy principle. The base should be wide enough to ensure adequate blood supply. 2. Craniotomy according to routine flap, bone flap or skin flap. 3. Remove the hematoma and completely stop bleeding. After seeing the hematoma through the bone flap, gently remove the hematoma from the dura mater with a stripper or a brain plate, or use a suction device to remove it. In case of active bleeding, the damaged blood vessels should be carefully searched for, and they should be coagulated or threaded through the ligation. When the middle meningeal artery that runs in the bone tube is broken, it can be treated by bone wax or small cotton ball packing. The injury of the superior sagittal sinus or transverse sinus is treated according to the repair method of sinus injury. For the oozing of small blood vessels on the surface of the dura mater, it is necessary to electrocoagulate and stop bleeding. 4. Suspend the dura mater and try to eliminate the dead space. After completely stopping bleeding, suspend the dura mater and periosteum with silk thread every 2 to 3 cm around the bone window. If there is still bleeding, a hemostatic sponge should be placed between the dura mater and the inner plate of the skull. For large bone flaps, it is necessary to drill with a Kirschner wire at the center of the bone flap to suspend the dura mater. 5. Drainage of the dura mater, bone flap reduction, suture the layers of the incision. complication 1. Postoperative recurrent hematoma and delayed hematoma. It should be discovered and disposed of in time. 2. Secondary brain swelling and cerebral edema should be properly controlled. 3. Long-term coma patients are prone to pulmonary infection, water and electrolyte balance disorders, hypothalamic dysfunction and malnutrition, etc., should be treated accordingly.

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