Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: An acute epidural hematoma (AEDH) is a severe complication of traumatic brain injury, occurring in 1%-3% of all head trauma cases. Herein, the authors report a rare case of AEDH in a 51-year-old male, with the AEDH extending bilaterally across the superior sagittal sinus (SSS) and into the infratentorial region following a fall. OBSERVATIONS: The patient underwent an emergency craniotomy and hematoma evacuation, and favorable outcomes were achieved. LESSONS: This case highlights the importance of utilizing surgical and skin incision positions that allow for adequate removal of AEDH and show the effectiveness of prompt surgical intervention. Bleeding from the venous sinus is common in epidural hematomas that extend above and below the dural tentorium and to both sides of the SSS. To ensure adequate hemostasis, the bony flap near the venous sinus should be preserved to achieve hemostasis. Excessive compression of the venous sinus should be avoided to prevent obstruction. If time permits, the morphology of the dural sinus should be confirmed through CT venography or MR venography. After craniotomy, the patient should be positioned to avoid air embolization from the site of venous sinus injury. https://thejns.org/doi/10.3171/CASE24756.

DOI： 10.3171/CASE24756

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Language：English   Publishing type：Research paper (scientific journal)  

We report a case of distal anterior cerebral artery (DACA) aneurysm presenting with subdural hematoma (SDH) without subarachnoid hemorrhage (SAH). A patient in his fifties presented with headache. Fluid-attenuated inversion recovery magnetic resonance imaging revealed SDH in the interhemispheric fissure and left frontotemporal region. SAH was not detected. Computed tomographic angiography revealed aneurysms in the left internal carotid artery (ICA) and DACA. The patient underwent frontotemporal craniotomy, which confirmed an unruptured ICA aneurysm, followed by bilateral frontal craniotomy for clipping of DACA aneurysm. The left DACA aneurysm was identified as the source of the SDH. Intraoperative findings showed adhesion between the aneurysm body and falx cerebri, explaining the SDH formation. Literature review identified only six reported cases of SDH without SAH due to DACA aneurysm. Evidence suggests that DACA aneurysms have a relatively higher propensity to cause SDH without SAH, likely due to the anatomical characteristics of the parent vessel and aneurysm projection.

DOI： 10.1093/jscr/rjae843

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