{"id":"9fc23709-0db5-4a01-a644-9f85f0525d83","slug":"expanding-contralateral-epidural-hematoma-causing-acute-intraoperative-brain-swelling","title":"Expanding contralateral epidural hematoma causing acute intraoperative brain swelling","authors":["Ali Tayebi Meybodi","Hooshang Saberi"],"abstract":"Background: The case presented involves a 28-year-old male with anisocoria and a depressed level of consciousness following head trauma. Initial imaging revealed a low CT cut with a relatively large frontal base hemorrhage, which contributed to a slight midline shift. The authors discuss the implications of frontal base hematomas and their potential to cause significant intracranial pressure changes. Methods: The authors emphasize the importance of monitoring during surgery, including checking the position of the endotracheal tube and monitoring arterial blood gases. They suggest that if brain swelling persists despite initial interventions, a large fronto-temporoparietal craniectomy should be performed to alleviate pressure. The need for immediate postoperative CT scans to assess for contralateral hematomas is also highlighted. Results: The authors note that the evacuation of the frontal hematoma was accompanied by acute brain swelling, which they argue should prompt further investigation for contralateral hematomas. They express concern that the initial craniectomy did not include the temporal region, which could be critical in cases of malignant intracranial hypertension. The presence of small blebs of pneumocephalus and a scant epidural hematoma were also observed. Conclusion: The authors advocate for a more aggressive surgical approach in cases of unexplained brain swelling during craniotomy, including the consideration of temporal craniectomy. They argue that the contralateral epidural hematoma may have expanded during the evacuation of the frontal hemorrhage, necessitating timely diagnosis and intervention. Keywords: epidural hematoma, brain swelling, craniotomy, intracranial pressure, surgery, head trauma, neurosurgery","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/9fc23709-0db5-4a01-a644-9f85f0525d83/featured/hero-1782420942008.png","publishDate":"2014-04-21T00:00:00.000Z","doi":"10.4103/2152-7806.131182","categories":["Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/9fc23709-0db5-4a01-a644-9f85f0525d83/pdf"}