Figure 1
Pre- and post-operative CT imaging. Pre-operative CT head non-contrast (A) axial and (B) coronal slices showing left temporal epidural hematoma (arrows) with maximal radial diameter of 16 mm, (C) the overlying oblique non-displaced fracture of the left temporal bone (arrow), which extends through the squamous portion into the petrous portion (not shown), and (D) contralateral right convexity contracoup SDH (arrow). There was also a small amount of air tracking into the Eustachian tube and surrounding the fracture, but no disruption of the petrous carotid was visible on angiography (also not shown.) This resulted in mild effacement of the ambient cisterns and right greater than left lateral ventricles without significant midline shift. Note that this epidural hematoma crosses the suture lines and may be confused with an SDH, but this is due to the dura's skull insertion disruption by the fracture. The largest lesion was directly visualized above the dura intraoperatively, although smaller subdural fluid collections and intraparenchymal contusions were visible after opening dura. Immediately post-operative head CT non-contrast, after left hemicraniectomy and cortical electrode placement in the frontal lobe and estimated location of the motor cortex (arrows) (E) scout reconstruction, shows placement of cortical electrodes over the left frontal and parietal lobes, and (F) axial slice shows post-operative localization of the frontal lobe EEG lead (arrow: motor cortex lead not shown in this slice) and (G) the same slice windowed for soft tissue to show substantial improvement in mass effect after evacuation.