Vertex epidural hematomas are very uncommon complications of traumatic head injury.Besides the volume of the epidural bleeding, compression of the superior sagittal sinus may be source for added elevated intracranial pressure. Clinical presentation of such lesions is heterogenous and symptoms can develop in an acute to a chronic frame. Radiological diagnosis can sometimes be challenging. Due to its rarity, such lesions have been only reported on case reports and small series and the management remain controversial. Hereby we report 3 cases of surgically managed post traumatic acute epidural hematomas of the vertex. Wen also went through a literature-based discussion of clinical, radiological and therapeutic features related to this condition.

Supratentorial-infratentorial epidural hematomas (SIEH) are a rare occurrence following traumatic head injuries, representing only 2% of traumatic epidural hematomas. Given the unique anatomical characteristics of the infratentorial region, mainly its small size, surgical intervention is commonly undertaken to alleviate the pressure on the posterior fossa components. Consequently, there is ongoing debate surrounding the optimal surgical approaches.In this report, we present four cases of SIEH that were treated surgically.Furthermore, we conduct a comprehensive review of existing literature, encompassing clinical, radiological, and therapeutic aspects associated with this condition.SIEH are uncommon post-traumatic lesions that require urgent and individualized management on a case-by-case basis, as guided by multiplanar cerebral computed tomography scan findings.Preoperative planning is essential; however, intraoperative exploration and identification of transverse sinus and torcula lesions are crucial for optimal patient care. The surgical approach may be modified intraoperatively based on the nature and extent of these lesions.In all cases, prompt hematoma evacuation and meticulous hemostasis are the two primary objectives of this surgery.

Penetrating intracranial foreign bodies are rare and have a high potential for death or serious morbidity. Their surgical management is complicated and challenging. Herein, we present the case of a 30-years-old man who was a victim of aggression from a rake blow to the head. The rake’s teeth were embedded in his cranium, crossing the midline. The surgery was delicate and had to be well studied because two of the rake’s teeth plunged into the superior sagittal sinus (SSS). The patient recovered a perfect state of consciousness and was discharged with squealer right upper limb monoparesia. Penetrating intracranial foreign bodies are rare. Few studies have reported on the removal of such foreign bodies, particularly in cases where the foreign body is close to or penetrates the SSS. They cause spectacular cranial trauma and a greater volume of the object. The aim of surgery is to remove the object without worsening the parenchymal and vascular cerebral lesions. This maneuver was delicate. A craniectomy is recommended around the penetrating object before it is carefully extracted with or without opening the dura mater.

Bilateral epidural hematoma is a rare presentation in head trauma injuries, accounting for only 1%–2% of all epidural hematomas, but with a higher mortality rate than the unilateral form. Herein, we report the case of a 27-year-old man admitted to our department following a road traffic accident. On admission,his Glasgow Coma Scale (GCS) score was 13/15. After a few minutes, he became comatose (GCS 6/15) with right anisocoria. CT scan revealed a bilateral asymmetric epidural hematoma with a left extralabyrinthic linear fracture. Surgical evacuation was subsequently performed, starting with the voluminous right hematoma. The patient was discharged on the 23rd postoperative day with a right third-nerve palsy. Conclusions: In this case report, we discuss the etiology, mechanism, and management of bilateral epidural hematoma. Early diagnosis and a judicious surgical approach for bilateral epidural hematoma are necessary to minimize mortality and morbidity. Prevention is key to reducing traumatic brain injuries.

Primary meningeal hemangiopericytoma (HPC) is a rare, aggressive dura based tumor that remarkably mimics a meningioma clinically and radiologically. Its occurrence within the cerebellopontine angle (CPA) is exceptional, and establishing the exact diagnosis is of the utmost importance since total resection remains the cornerstone of treatment. A 42-year-old man presented with a three-month history of progressively worsening vertigo and difficulty in walking. On admission, his neurological examination revealed a right peripheral facial palsy, right abducens palsy and left hemiparesis, suggesting the diagnosis of Millard-Gubler syndrome. Computed tomography and magnetic resonance imaging demonstrated a homogeneously enhancing dura based lesion of the right CPA causing major brain stem compression. There was no widening of the ipsilateral internal auditory canal. A standard retrosigmoid craniotomy was performed to access the right CPA. Exposure of the lesion revealed a well-encapsulated, gray, fibrous lesion, which appeared to originate from the tentorium. Gross total resection was achieved and confirmed radiologically. The microscopic features and the immunohistochemical profile confirmed the diagnosis of a HPC, and adjuvant radiation therapy was administered. Ten years later, the patient presented with a severe neurological deficit due to a local recurrence, but at that time refused any second intervention. He died three months later. HPC can locate within the CPA and present as a Millard-Gubler syndrome. The diagnosis should be kept in mind in case of a CPA dura based tumor. Radical surgery plus radiation therapy can maximize the recurrence-free survival and close follow-up remains mandatory to spot recurrences early.
Adult ; Brain Stem ; Cerebellopontine Angle* ; Clothing* ; Craniotomy ; Diagnosis ; Facial Paralysis ; Follow-Up Studies ; Hemangiopericytoma* ; Humans ; Magnetic Resonance Imaging ; Meningioma ; Neurologic Examination ; Paralysis ; Paresis ; Recurrence ; Vertigo ; Walking ; Wolves*

Primary meningeal hemangiopericytoma (HPC) is a rare, aggressive dura based tumor that remarkably mimics a meningioma clinically and radiologically. Its occurrence within the cerebellopontine angle (CPA) is exceptional, and establishing the exact diagnosis is of the utmost importance since total resection remains the cornerstone of treatment. A 42-year-old man presented with a three-month history of progressively worsening vertigo and difficulty in walking. On admission, his neurological examination revealed a right peripheral facial palsy, right abducens palsy and left hemiparesis, suggesting the diagnosis of Millard-Gubler syndrome. Computed tomography and magnetic resonance imaging demonstrated a homogeneously enhancing dura based lesion of the right CPA causing major brain stem compression. There was no widening of the ipsilateral internal auditory canal. A standard retrosigmoid craniotomy was performed to access the right CPA. Exposure of the lesion revealed a well-encapsulated, gray, fibrous lesion, which appeared to originate from the tentorium. Gross total resection was achieved and confirmed radiologically. The microscopic features and the immunohistochemical profile confirmed the diagnosis of a HPC, and adjuvant radiation therapy was administered. Ten years later, the patient presented with a severe neurological deficit due to a local recurrence, but at that time refused any second intervention. He died three months later. HPC can locate within the CPA and present as a Millard-Gubler syndrome. The diagnosis should be kept in mind in case of a CPA dura based tumor. Radical surgery plus radiation therapy can maximize the recurrence-free survival and close follow-up remains mandatory to spot recurrences early.
Adult ; Brain Stem ; Cerebellopontine Angle* ; Clothing* ; Craniotomy ; Diagnosis ; Facial Paralysis ; Follow-Up Studies ; Hemangiopericytoma* ; Humans ; Magnetic Resonance Imaging ; Meningioma ; Neurologic Examination ; Paralysis ; Paresis ; Recurrence ; Vertigo ; Walking ; Wolves*