Abstract：
OBJECTIVE: Vertex epidural hematoma (VEDH) is a relatively uncommon type of intracranial hematoma. Because of its unique location and the potential of massive intraoperative bleeding, diagnosis and surgical intervention of VEDH may be challenging.
METHODS: A retrospective analysis of 32 patients with VEDH was undertaken to investigate the prognostic factor and therapeutic strategy of VEDH. Special attention was paid to the relationship between fracture pattern, surgical method, intraoperative blood loss and outcome.
RESULTS: Patients treated surgically had a higher percentage of consciousness disturbance and a significantly larger size of VEDH compared with patients treated conservatively (p = 0.029 and p < 0.0001, respectively). Bleeding from the injured superior sagittal sinus (SSS) was noted in six of nine patients (67%) with a linear fracture parallel to the SSS. Only one patient (20%) with a linear fracture crossing the SSS had bleeding from the injured SSS. Five of eight patients (63%) with sagittal suture diastasis experienced bleeding from the SSS. All patients with massive blood loss and six of seven patients developing intraoperative shock had copious bleeding from the injured SSS. All patients with intraoperative massive bleeding and shock underwent traditional \"simple craniotomy\". No patients undergoing \"strip craniotomy\" experienced massive bleeding. Thrombocytopenia (p = 0.008), headache (p = 0.015), consciousness disturbance (p = 0.043), pupil reactivity (p = 0.010), GCS score (p < 0.0001) and the relationship between skull fracture and the SSS (p = 0.037) were significant prognostic factors.
CONCLUSIONS: Our study demonstrated GCS score may be a significant prognostic factor in patients with VEDH. Bleeding from the injured SSS occurred frequently in VEDH patients with a linear skull fracture parallel to the SSS or sagittal suture diastasis and could cause devastating hemorrhage. When operating on such patients, the surgical team should prepare for the possibility of massive blood loss and intraoperative shock. Bilateral parasagittal craniotomies with preservation of a central bone strip containing the sagittal suture (strip craniotomy) to allow application of tack-up sutures from the dura to the bone strip may be more suitable for VEDH evacuation.
METHODS: A retrospective analysis of 32 patients with VEDH was undertaken to investigate the prognostic factor and therapeutic strategy of VEDH. Special attention was paid to the relationship between fracture pattern, surgical method, intraoperative blood loss and outcome.
RESULTS: Patients treated surgically had a higher percentage of consciousness disturbance and a significantly larger size of VEDH compared with patients treated conservatively (p = 0.029 and p < 0.0001, respectively). Bleeding from the injured superior sagittal sinus (SSS) was noted in six of nine patients (67%) with a linear fracture parallel to the SSS. Only one patient (20%) with a linear fracture crossing the SSS had bleeding from the injured SSS. Five of eight patients (63%) with sagittal suture diastasis experienced bleeding from the SSS. All patients with massive blood loss and six of seven patients developing intraoperative shock had copious bleeding from the injured SSS. All patients with intraoperative massive bleeding and shock underwent traditional \"simple craniotomy\". No patients undergoing \"strip craniotomy\" experienced massive bleeding. Thrombocytopenia (p = 0.008), headache (p = 0.015), consciousness disturbance (p = 0.043), pupil reactivity (p = 0.010), GCS score (p < 0.0001) and the relationship between skull fracture and the SSS (p = 0.037) were significant prognostic factors.
CONCLUSIONS: Our study demonstrated GCS score may be a significant prognostic factor in patients with VEDH. Bleeding from the injured SSS occurred frequently in VEDH patients with a linear skull fracture parallel to the SSS or sagittal suture diastasis and could cause devastating hemorrhage. When operating on such patients, the surgical team should prepare for the possibility of massive blood loss and intraoperative shock. Bilateral parasagittal craniotomies with preservation of a central bone strip containing the sagittal suture (strip craniotomy) to allow application of tack-up sutures from the dura to the bone strip may be more suitable for VEDH evacuation.
摘要：
目的：顶点硬膜外血肿（VEDH）是一种相对少见的颅内血肿。由于其独特的位置和术中大量出血的可能性，VEDH的诊断和手术干预可能具有挑战性。
方法：对32例VEDH患者进行回顾性分析，探讨VEDH的预后因素和治疗策略。特别注意断裂模式之间的关系，手术方法,术中失血量和预后。
结果：与保守治疗的患者相比，手术治疗的患者意识障碍的百分比更高，VEDH的大小明显更大（分别为p=0.029和p<0.0001）。9例患者中有6例（67％）出现平行于SSS的线性骨折，受伤的上矢状窦（SSS）出血。只有一名穿过SSS的线性骨折患者（20％）因受伤的SSS而出血。8例矢状缝合术患者中有5例（63％）经历了SSS出血。所有大量失血的患者和7例发生术中休克的患者中的6例都因受伤的SSS而大量出血。所有术中大出血和休克的患者均接受传统的“简单开颅术”。没有接受“带状开颅手术”的患者出现大量出血。血小板减少症（p=0.008），头痛（p=0.015），意识障碍（p=0.043），瞳孔反应性（p=0.010），GCS评分（p<0.0001）和颅骨骨折与SSS之间的关系（p=0.037）是重要的预后因素。
结论：我们的研究表明GCS评分可能是VEDH患者的重要预后因素。VEDH患者经常发生受伤的SSS出血，其线性颅骨骨折平行于SSS或矢状缝线切开，并可能导致破坏性出血。对这类病人进行手术时，手术团队应该为大量失血和术中休克的可能性做好准备。保留包含矢状缝合线的中央骨条的双侧矢状旁开颅术（带状开颅术），以允许从硬脑膜到骨条的固定缝合线的应用可能更适合VEDH疏散。
方法：对32例VEDH患者进行回顾性分析，探讨VEDH的预后因素和治疗策略。特别注意断裂模式之间的关系，手术方法,术中失血量和预后。
结果：与保守治疗的患者相比，手术治疗的患者意识障碍的百分比更高，VEDH的大小明显更大（分别为p=0.029和p<0.0001）。9例患者中有6例（67％）出现平行于SSS的线性骨折，受伤的上矢状窦（SSS）出血。只有一名穿过SSS的线性骨折患者（20％）因受伤的SSS而出血。8例矢状缝合术患者中有5例（63％）经历了SSS出血。所有大量失血的患者和7例发生术中休克的患者中的6例都因受伤的SSS而大量出血。所有术中大出血和休克的患者均接受传统的“简单开颅术”。没有接受“带状开颅手术”的患者出现大量出血。血小板减少症（p=0.008），头痛（p=0.015），意识障碍（p=0.043），瞳孔反应性（p=0.010），GCS评分（p<0.0001）和颅骨骨折与SSS之间的关系（p=0.037）是重要的预后因素。
结论：我们的研究表明GCS评分可能是VEDH患者的重要预后因素。VEDH患者经常发生受伤的SSS出血，其线性颅骨骨折平行于SSS或矢状缝线切开，并可能导致破坏性出血。对这类病人进行手术时，手术团队应该为大量失血和术中休克的可能性做好准备。保留包含矢状缝合线的中央骨条的双侧矢状旁开颅术（带状开颅术），以允许从硬脑膜到骨条的固定缝合线的应用可能更适合VEDH疏散。
