Prevention of Cerebral Herniation by Decompressive Craniotomy in a Child with Acute Peritentorial Subdural Hematoma and Brain Edema: A Case Report

Abstract

Acute subdural bleedings developing subsequent to head traumas are frequently observed on the outer surfaces of brain convexities, but may very rarely be observed on the upper surface of tentorium (peritentorial area) as well [1,2]. The literature data demonstrate that it is particularly observed as a result of post-partum trauma in difficult births in the newborn. It may be difficult to determine these bleedings on the tentorial surface via routine axial computed tomographic sections. Coronal and sagittal plain images other than the classic sections should also be obtained. However, despite these new imaging techniques, bleedings of this localization are not frequently encountered. Furthermore, it may be misdiagnosed due to co-existing bleedings and a complicated clinical course in patients with severe head trauma. The main problem is to determine the appropriate approach in the presence of a life-threatening bleeding in the peritentorial localization that causes uncal herniation.