Acute epidural hematoma extending bilaterally and infratentorially: illustrative case.

backgroundAn 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.