Vertex epidural haematoma secondary to sagittal sinus involvement: a surgical challenge

Epidural haematomas (EDHs) involving the superior sagittal sinus (SSS) are rare and carry significant surgical risks. We report a man in his 50s who sustained an occipital head injury secondary to a tonic-clonic seizure. Initial imaging revealed a large occipital EDH displacing the SSS, associated with a bifocal parietal fracture. Despite neurological stability and no radiological evidence of active bleeding, conservative management was initially chosen due to high surgical risk and thrombocytopenia. The patient later developed recurrent seizures with rapid neurological deterioration, prompting urgent surgical evacuation after platelet transfusion. Bilateral parasagittal craniotomies preserving a midline bony bridge were performed, allowing effective decompression while avoiding direct SSS manipulation. The patient recovered neurologically and was discharged home with a good functional outcome. This case underscores the need for dynamic clinical assessment and individualised surgical strategies in EDHs involving the SSS, balancing the risks of intervention against potential neurological deterioration.