Intraoperative Contralateral Massive Extradural Hematoma Development During Decompressive Craniectomy and Evacuation of Traumatic Acute Subdural Hematoma Causing Brain Bulge: Management

Sequential development of extradural hematoma (EDH) during decompressive craniotomy and evacuation for acute subdural hematoma (ASDH) causing massive brain bulge is rare, it may represent to be first indication of hematoma development. About thirty seven cases are published in the form of isolated case report till date. Management is debated, as first to carry out exploratory burr-hole or necessity of getting CT scan head or intraoperative ultrasonography imaging to ascertain the diagnosis. Authors report a 40-year male, who developed EDH on contralateral side during evacuation of traumatic acute subdural hematoma during intraoperative period, wound was closed, patient was directly shifted to CT scan suit and got CT scan revealed ED, underwent evacuation of EDH by retuning back with good outcome. Awareness of occurrence of EDH development as a cause of massive intraoperative brain bulge, which is not getting relieved on routine anaesthetic measure, may need urgent CT scan or at least intraoperative ultrasonography imaging is to diagnose early and provide appropriate management.