• Doğan Güçlühan Güçlü, Onur Öztürk, Musa Çırak, Halil Can, Tuğrul Cem Ünal, İlyas Dolaş, Utku Özgen, Aydın Aydoseli, and Altay Sencer.
• Department of Neurosurgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul-Turkey.
• Ulus Travma Acil Cer. 2022 Jun 1; 28 (6): 805811805-811.

BackgroundSupratentorial midline epidural hematoma is rare but challenging in diagnosis and management. Indication for surgery can arise even following hospital admission. Being familiar to the presentation and watching out for direct and indirect signs on axial computed tomography (CT) such as suture diastasis or fracture traversing midline are essential to plan multi-planar CT enabling exact diagnosis including form and mass effect of hematoma.MethodsNine patients with midline epidural hematoma including two pediatric patients underwent surgery between 2013 and 2018. Pre-operative and post-operative patient status, radiological features, and surgical technique were analyzed.ResultsFour patients had deteriorating consciousness levels and two patients had paraparesis. All had fractures traversing midline and epidural hematomas with significant mass effect. They were operated through separated craniotomies around the midline and midline bone strip was used for dural tenting and as support for natural closure of bone flaps. No post-operative complications were developed. All patients were discharged with Glasgow Outcome Score of 5.ConclusionBecause of the rarity of the lesion and small number of patients, definitive conclusions may be misleading but we think that, in experienced hands, midline epidural hematomas can safely be operated on and, preservation of midline bone strip pro-vides easier bleeding control.

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