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.

• 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

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

• 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

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

• Subdural hematoma
• Intracerebral hemorrhage
• Tension pneumocephalus
• Stroke or infarction

• 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

• Favorable if detected and treated early
• Delayed diagnosis may lead to irreversible brain damage or death

• 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