RESUMO
BACKGROUND: Traumatic orbital encephaloceles are rare but severe complications of orbital fractures. These encephaloceles can present months to years after the initial injury. OBSERVATIONS: The authors present two cases of traumatic orbital encephalocele in young males struck by motor vehicles. LESSONS: The exact traumatic mechanism of these encephaloceles is unknown, and diagnosis can be confounded by concomitant injuries. The use of a minimally invasive supraorbital keyhole craniotomy has the potential to change how this disease process is managed and has not been previously documented in this setting.
RESUMO
BACKGROUND: Epidural hematoma (EDH) can result in a catastrophic outcome of traumatic brain injury. Current management guidelines do not consider the source of hemorrhage in decision making. The purpose of this study was to examine the relationship between EDH location and the source of hemorrhage. METHODS: We report retrospectively reviewed, prospectively obtained surgical data of patients with acute traumatic cranial EDH treated between 2007 and 2018. Computed tomography (CT) scans were used to categorize EDH location as lateral or medial. The source of hemorrhage was identified intraoperatively by a single surgeon. RESULTS: Overall, of 92 evacuated EDHs (in 87 patients), 71 (77.2%) were in the lateral location. Arterial bleeding was the cause of EDH in 63.4% of the lateral EDHs and 9.2% of the medial EDHs (P < 0.0001). In the cases where surgery was done primarily to treat EDH, 65.3% had an arterial bleed source (P < 0.0001). In those treated for primary reasons other than EDH evacuation, 75% had a venous bleed source (P = 0.002). CONCLUSIONS: The location of EDH correlates with the source of hemorrhage. The decision to operate on EDH may be influenced by this factor.