Book craniotomy: modified craniotomy for midline extradural hematoma. Patient series.

Background: An extradural hematoma (EDH) is an acute blood collection between the dura and calvarium in the skull and the spine. The most common cause is traumatic and the most common location is the temporal convexity. A midline or vertex EDH from a venous bleed, most commonly from the midline sinuses, is rare.

Observations: The authors present a case series of 9 cases of vertex EDH managed in their department.The common cause was road traffic accidents. Vertex EDH was the most common type. Book craniotomy was considered in all cases. A definite sinus injury was seen in 5 cases. No patients died. Book craniotomy is an innovative method to manage midline EDH when there is a risk of sinus injury.

Lessons: A midline EDH is not common and needs special attention. Surgical treatment can lead to profuse blood loss due to an underlying sinus injury and patient morbidity. Book craniotomy is an innovative method to safeguard the sinuses in cases of midline EDH and achieve hemostasis. https://thejns.org/doi/10.3171/CASE2518.