Chapter 6 - Evacuation of Acute Epidural and Subdural Hematomas
from Section 3 - Head
By Gabriel Zada, Kazuhide Matsushima
Edited by Demetrios Demetriades, University of Southern California, Kenji Inaba, University of Southern California, George Velmahos
Book: Atlas of Surgical Techniques in Trauma
Published online: 21 October 2019
Print publication: 02 January 2020, pp 38-46
There are three meninges covering the brain: the dura mater, the arachnoid mater, and the pia mater.
The dura mater is the thickest and strongest membrane, and is firmly attached to the inner surface of the cranial bone, especially along the sutures. It contains the meningeal arteries.
The arachnoid mater is a thin membrane under the dura mater. Its inner surface has numerous thin trabeculae extending downward, into the subarachnoid space.
The pia mater is a thin membrane that covers the surface of the brain, entering the grooves and fissures.
Due to the tight adhesion of the dura mater to the inner skull, significant force is required to separate them. In contrast, separation of the dura from the subarachnoid mater can occur with relatively little force.
The middle meningeal artery arises from the external carotid artery. It enters the foramen spinosum and branches into the anterior, middle, and posterior branches with various patterns. It is a common source of bleeding in acute epidural hematomas (EDHs).
The bridging veins connect the cortical superficial veins to the sagittal sinus in the dura. They are a common source of bleeding in acute subdural hematomas (SDHs).
By Howard Belzberg, Elizabeth R. Benjamin, Charles Best, Mark W. Bowyer, Demetrios Demetriades, Heidi L. Frankel, Rondi Gelbard, Daniel J. Grabo, Peter Hammer, Kenji Inaba, Emilie Joos, Mark Kaplan, Edward Kwon, Lydia Lam, Jackson Lee, Kazuhide Matsushima, Nicholas Nash, Daniel Oh, Eric Pagenkopf, Vincent L. Rowe, Lisa L. Schlitzkus, Jennifer Smith, Matthew D. Tadlock, Peep Talving, Pedro G. Teixeira, Stephen Varga, George Velmahos, Kelly Vogt, Gabriel Zada, Scott Zakaluzny
Edited by Demetrios Demetriades, Kenji Inaba, George Velmahos
Print publication: 05 March 2015, pp ix-x
Print publication: 05 March 2015, pp 35-46