case_images: PMC10629312_01
case_images: Preoperative computed tomography scan of the head bony window showing fractured occipital bone (thick arrow and thin arrow).
case_images: SNI-14-369-g001.jpg
case_images: PMC10629312_01_SNI-14-369-g001.jpg
case_images: F1
case_images: Initial CT head scans after 6 h from injury showed a fracture in the occipital bone [Figure 1] along with EDH in both supratentorial and infratentorial compartments bilaterally [Figures 2a and b].
case_images: (a) Preoperative axial computed tomography (CT) scan head showing posterior fossa Epidural hematoma (EDH) with swirl sign (thin arrow) (b) preoperative sagittal CT scan head showing EDH in both supratentorial and infratentorial compartments (thin arrow).
case_images: SNI-14-369-g002.jpg
case_images: PMC10629312_01_SNI-14-369-g002.jpg
case_images: F2
case_images: Initial CT head scans after 6 h from injury showed a fracture in the occipital bone [Figure 1] along with EDH in both supratentorial and infratentorial compartments bilaterally [Figures 2a and b]. Complete obliteration of the transverse sinus with a swirl sign was seen in the scan [Figure 2a]. 4th ventricular obliteration with proximal ventriculomegaly was also seen.
case_images: (a) Preoperative axial computed tomography (CT) scan head after 24 h of admission showing an increase in the size of hematoma (thin arrow) with an increase in the size of temporal horns (thick arrow) (b) preoperative sagittal CT scan head after 24 h of admission showing an increase in the size of hematoma (thin arrow).
case_images: SNI-14-369-g003.jpg
case_images: PMC10629312_01_SNI-14-369-g003.jpg
case_images: F3
case_images: It showed an increase in the size of the hematoma from 20.6 mL to 32.6 mL which led to severe compression on the brain stem with proximal hydrocephalus as manifested by an increase in the size of temporal horns [Figures 3a and b].
case_images: Intraoperative image showing two burr holes in supratentorial compartments which are enlarged by Kerrison punch (thin arrows) and small craniectomy in infratentorial compartment covered by gel foam (thick arrow).
case_images: SNI-14-369-g004.jpg
case_images: PMC10629312_01_SNI-14-369-g004.jpg
case_images: F4
case_images: In a prone position under general anesthesia, a midline incision was made and a small infratentorial craniectomy for infratentorial EDH was done along with two burr holes made above transverse sinus bilaterally for supratentorial EDH and slightly enlarged with Kerrison punch [Figure 4].
case_images: (a) Postoperative axial computed tomography (CT) scan head on day 1 showing evacuated Epidural hematoma (EDH) (thin arrow) and decrease in size of ventricles (thick arrow) (b) postoperative sagittal CT scan head showing evacuated infratentorial EDH (thin arrow) and a small amount of residual blood (thick arrow).
case_images: SNI-14-369-g005.jpg
case_images: PMC10629312_01_SNI-14-369-g005.jpg
case_images: F5
case_images: Postoperative scans showed evacuated EDH with a small amount of residual blood along the transverse sinus [Figures 5a and b]. 4th ventricle was also visualized with a decrease in the size of the ventricles [Figure 5a]. The transverse sinus was completely visualized in scans [Figure 5b].