Introduction: Certain Large Epidural hematomas are life threatening because they cause increase in intracranial pressure, compress delicate brain tissue, and cause brain shift . Around 15 to 20% of epidural hematomas are fatal.
Methods: Surgical treatment of epidural hematomas involves opening the calvaria over the site of the hemorrhage. The EDH is readily apparent after elevating the bone flap, and it is removed Epidural tack-up sutures are placed from the dura to the craniotomy bone edge and to the center of the craniotomy flap to tamponade epidural bleeding from areas beyond the craniotomy edges and to prevent recurrence.Some times brain compression due to EDH is so massive, especially in elderly due to cerebral atrophy and convexity EDH brain does not come up after removal of hematoma.There is a big gap between the inner surface of bone and dura mater and brain takes too much time to come up ,when surgeons apply hitch stitches, there is tenting of duramater and a lot of space is left between dura and skull which is refilled with blood.In such condition we injected normal saline beneath the dura,with the help of intracath no.18,so that the dura just comes near the bony inner surface then good haemostatic dural hitch stitches(Epidural Tack-up sutures) were applied.During post op period the brain gradually comes up and the saline comes out through the dural rent ,made by intracath, and is absorbed gradually.
Results: We have used this technique in twenty five patients in last two years and good dural haemostasis was achieved in all patients, no post op collection and recurrence noted.
Conclusions: : The dural lift technique is good surgical technique for management of massive EDH
Patient Care: Reducing surgery and aneasthesia time and decreases blood lose.
Learning Objectives: It is effective and time saving technique for EDH evacuation.
References: Principles of neurosurgery,by Setti S Rengachary
Text book of head injury by A K Mahapatra and Raj Kamal