[Midline and vertex epidural hematomas: clinical aspects, surgical indications and therapy]

Within a group of 315 epidural haematomas treated surgically 8 (2.5%) were located within the midline or at the vertex. The clinical symptoms may be small in frontally located haematomas. Paraparesis is caused by a haematoma localized at the vertex. The latter may be misinterpreted as a spinal trauma. The recognition of the hyperdense blood within the last slices of normal CT scans needs experience. It has been misinterpreted as hyperostosis of the skull. We present a group of eight personal cases. The sagittal skull suture was fractured in seven patients. One patient already had an 11-month history. Four cases were primary and had not been recognized. The prognosis depends on concomitant primary brain injuries. Early diagnosis with operative treatment given the best chance. Polytraumatized patients with concomitant injuries die. Slowly developing haematomas do not require acute surgery by in experienced surgeons. Sagittal sinus laceration must be treated by experienced neurosurgeons. It can be closed by suturing the dura to the bone with implanted collagen. In subacute cases the stiffness of the dura allows no normalization of the dura position. A dural graft is necessary for repositioning.