Introduction: Epidural hematomas (EDHs) involving the venous sinuses are uncommon and may be challenging to treat given the risk of infarction, hemorrhage, or venous air embolism. We report our series for superior sagittal sinus (SSS) and transverse sinus (TS) related EDHs including surgical and nonsurgical management.
Methods: A retrospective review of the EDH cases at our center was performed from 2013-2018. Patients were stratified by surgical versus conservative management, as well as location. Outcomes and complications were determined.
Results: Of the 268 EDH patients identified, 32 involved either the SSS or TS. 10 patients had SSS and 22 had TS EDHs. Ten of the patients had surgery and 22 were managed conservatively. Of the surgical patients, five had SSS EDHs and five had TS EDHs. No surgical complications occurred in this series. Of the surgical patients, all but one were awake and alert at discharge with a Modified Rankin Score (mRS) of 0 or 1 at follow up. All of the nonsurgical patients were discharged without neurological deficit. Of those that followed up, all had an mRS of 0 or 1 except for one patient with prior disability.
Conclusions: Surgical and nonsurgical management of EDHs involving the venous sinuses are both viable options with good outcomes. Surgical intervention is based on location, size, neurological exam, expansion on serial imaging, and vascular imaging findings. Surgery has the potential for catastrophic complications, but all patients in our series had good outcomes at 6 weeks. Similarly, nonsurgical management had good outcomes, and our overall series demonstrates better outcomes with fewer complications than other similar series in the literature.
Patient Care: Our results will improve future management of patient's who present with epidural hematomas involving a venous sinus by offering a multiple management approaches based on initial presentation.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the outcomes in patients with EDHs associated with venous sinuses, 2) Discuss conservative versus surgical management of EDHs associated with venous sinuses, 3) Identify which patients should be managed conservatively versus surgically.