🧠 Postoperative Epidural Hematoma (EDH) [Neurosurgery Wiki]

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===== 🧠 Postoperative Epidural Hematoma (EDH) =====

==== 📌 Definition ====
A **postoperative epidural hematoma** is a **collection of blood between the inner surface of the skull and the dura mater** that develops after a craniotomy. It may occur adjacent to or remote from the surgical site and can be life-threatening due to mass effect.

==== ⚠️ Etiology and Mechanisms ====
  * Intraoperative injury to dural vessels (e.g., middle meningeal artery)
  * Inadequate hemostasis or dural detachment
  * Loss of tamponade effect due to craniectomy or drain over-suction
  * Coagulopathy or use of anticoagulants/NSAIDs
  * Sudden postoperative hypertension
  * Remote EDH: occurs distant from surgical site due to pressure shifts

==== 🧪 Incidence ====
  * Rare but serious: ~0.5% to 2.5% after supratentorial craniotomy
  * Often occurs within the first 6–24 hours postoperatively

==== 🩺 Clinical Presentation ====
  * Decreased level of consciousness (somnolence → coma)
  * New-onset anisocoria or pupillary changes
  * Headache, nausea, vomiting
  * Seizures
  * Delayed awakening from anesthesia
  * Neurological deterioration after initial recovery

==== 🖼️ Imaging Findings ====
  * **CT scan**: biconvex (lens-shaped), hyperdense extraaxial collection
  * Mass effect, midline shift
  * May appear **ipsilateral or contralateral** to craniotomy site

==== 🧠 Differential Diagnosis ====
  * Subdural hematoma
  * Intracerebral hemorrhage
  * Tension pneumocephalus
  * Stroke or infarction

==== 🛠️ Management ====
  * **Emergency re-craniotomy and evacuation** if symptomatic or with mass effect
  * ICU monitoring and neurosurgical follow-up
  * Correction of coagulopathy (platelets, FFP, reversal agents)
  * BP control to avoid further bleeding

==== 📉 Prognosis ====
  * Favorable if detected and treated early
  * Delayed diagnosis may lead to irreversible brain damage or death

==== 🧾 Prevention ====
  * Careful intraoperative hemostasis
  * Judicious use of suction drains
  * Postoperative blood pressure control
  * Early CT scan (especially if neurological change)
  * Cautious NSAID use in high-risk patients