A 30-year-old male, was admitted 1.5 hrs following trauma, with a GCS score of 7/15 and asymmetric but reacting pupils. A CT scan of the brain showed an acute SDH in the right fronto-temporo-parietal region with mass effect and midline shift []. There was also a thin EDH and a speck of extradural air in the contralateral temporal region, underlying an undisplaced fracture of the parietal bone, and diastasis of the squamosal suture [Figure and ]. He underwent emergency surgical evacuation of the SDH. A lax duroplasty, was performed, and the bone flap was not replaced, as the brain was tense. He remained under ventilator support, with the pupils equal and reacting to light. An hour later, his left pupil became dilated and nonreacting. A CT scan of the brain showed a large contralateral EDH and a thin SDH with midline shift, subfalcine, and uncal herniation []. The EDH showed mixed densities and “swirl sign” suggesting active hemorrhage. He underwent an emergency craniotomy, evacuation of the left EDH, and bipolar coagulation of the actively bleeding posterior branch of the middle meningeal artery (MMA). The dura was not opened, as the SDH was thin and the dura was lax after the evacuation of the EDH. Postoperatively, the pupils were again equal and reacting to light. A follow-up CT scan of the brain showed no residual EDH and a thin acute SDH []. His GOS-E was 7 (lower good recovery), at 6 months.
A 51-year-old female was admitted with a head injury after a pedestrian accident. Upon admission, one hour after the accident, she had a GCS of 14. Brain CT revealed an EDH in the right temporoparietal area, SDH in the left frontal area (), and skull fracture in the right temporal and left frontal bone. Emergency right craniotomy was performed and the EDH was evacuated. Softened dura matter was found after performing craniectomy. Intraoperative TCS applied to the craniectomy site revealed volume expansion of the EDH in the left frontal area (). The bone flap was repositioned. Her vital signs were stable, and she was transported to the CT room. Brain CT confirmed the presence of a de novo EDH in the left frontal area. As a result, a second operation was performed on the left side. Her postoperative GCS score was 14, and the patient was discharged on hospital day 20 with no definite neurological deficit.