Elsevier

World Neurosurgery

Volume 110, February 2018, Pages 492-498.e3
World Neurosurgery

Case Report
The Relationship Between Hematoma and Pachymeninges in an Interdural Hematoma: Diagnosis and Surgical Strategy

https://doi.org/10.1016/j.wneu.2017.11.040Get rights and content
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Background

The exact location of a hematoma in relation to the pachymeninges contributes to typical radiographic presentations. However, because of the complexity of hematoma evolution and neomembrane formation, an unexpected intraoperative finding can lead to a change of surgical strategy. In addition, the concentration of hemoglobin and its degradation products, the integrity of red blood cells, and the infiltration of fibroblasts, polymorphonuclear neutrophils, and macrophages are factors that affect the imaging characteristics on computed tomography and magnetic resonance imaging as the hematoma ages.

Case Description

An interdural hematoma (IDH)—a hemorrhage that splits the periosteal dura mater from the meningeal dura mater—is an extremely rare occurrence, and the diagnosis requires confirmation by surgical or pathologic findings. By presenting a case of an IDH that was misdiagnosed as a chronic subdural hematoma before surgery, and reviewing the literature, we propose the radiologic characteristics of presenting both dural border sign and dural beak sign on magnetic resonance imaging as a specific indicator for IDH preoperatively.

Conclusions

A careful evaluation of cerebral expansion before membranectomy was mandatory intraoperatively. For IDH, wide inner membranectomy (i.e., excision of meningeal dura mater) should not be necessary. An IDH should be considered as a distinct disease category when evaluating an extra-axial hematoma despite its rarity, because the characters of radiologic, histopathologic findings are different. In addition, surgical strategy varies for epidural or subdural hematoma in different hematoma stages.

Key words

Burr-hole craniostomy
Chronic subdural hematoma
Interdural hematoma
Lymphocyte infiltration
Magnetic resonance imaging
Organized hematoma

Abbreviations and Acronyms

ADC
Apparent diffusion coefficient
ASDH
Acute subdural hematoma
CSF
Cerebrospinal fluid
CT
Computed tomography
DWI
Diffusion-weighted imaging
EDH
Epidural hematoma
MetHb
Methemoglobin
MRI
Magnetic resonance imaging
sASDH
Subacute subdural hematoma
SDH
Subdural hematoma

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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