Association between spontaneous intracranial epidural hematoma and craniofacial infections: A systematic literature review

Abstract

Background: Spontaneous and nontraumatic epidural hematoma (SEDH) is a rare entity. Etiology is various, including vascular malformations of the dura mater, hemorrhagic tumors, and coagulation defects. The association between SEDH and craniofacial infections is rather unusual.

Methods: We performed a systematic review of the available literature using the PubMed, Cochrane Library, and Scopus research databases. Literature research was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We exclusively included studies reporting demographic and clinical data, published until October 31, 2022. We also report one case from our experience.

Results: A total of 18 scientific publications, corresponding to 19 patients, met the inclusion criteria for the qualitative and quantitative analysis. Patients were mostly adolescents, with a clear male predominance. SEDHs frequently occurred in the frontal area, usually near the site of the infection. Surgical evacuation was the treatment of choice with good postoperative outcomes. Endoscopy of the involved paranasal sinus should be achieved as soon as possible to remove the cause of the SEDH.

Conclusion: SEDH may occur as a rare and life-threatening complication of craniofacial infections; therefore, prompt recognition and treatment are mandatory.

Keywords: Epidural; Hematoma; Infection; Intracranial; Spontaneous; Surgery and antibiotics.

Figure 1:

PRISMA flow-chart showing information sources, search strategy, and study selection. PRISMA: Preferred reporting items for systematic reviews and meta-analyses.

Figure 2:

Preoperative brain computed tomography scan showing a voluminous right frontal extradural hematoma, along with inflammatory hypodense tissue in the left ethmoidal cells (b), maxillary (a), and frontal (c) sinuses. No evidence of skull fractures.

Figure 3:

High-resolution paranasal computed tomography scan performed before functional endoscopic sinus surgery. Note the opacification of the left maxillary (b, spotted arrow), ethmoidal (a, black arrow), and frontal sinuses (b, white arrow).

Figure 4:

Postoperative brain magnetic resonance imaging (a: T2-weighted image, b: T1-weighted image after injection, c: fluid-attenuated inversion recovery section) showing no recurrences of the epidural hematoma, in the absence of images consistent with vascular malformations of the dura mater.