[Abstract] Objective To investigate the clinical characteristics and early diagnosis and treatment of progressive postoperative dural epidural hematoma (TPEDH) after craniocerebral trauma. Methods The data of 34 cases of postoperative TPEDH after craniocerebral trauma were retrospectively analyzed, and their clinical manifestations, CT examination findings, and treatment results were summarized. Results Among the 34 cases of TPEDH in this group, there were 8 cases of adjacent type and 26 cases of distant septal type; 30 cases were unilateral and 4 cases were bilateral; the most common cases were temporoparietal and occipitoparietal. The main manifestations were no significant improvement of consciousness impairment or new manifestations of neurological dysfunction after surgery. Thirty-three cases were reoperated, and the presence of fracture at the hematoma was confirmed in 32 cases. The GOS score at discharge was 5 in 12 cases, 4 in 8 cases, 3 in 6 cases, and 1 in 8 cases. Conclusion Postoperative TPEDH is mostly seen at the site of impact, and early CT review helps to make timely diagnosis and improve prognosis. [Keywords] Cranial trauma, progressive epidural hematoma, prognosis Traumatic epidural hematoma (EDH) accounts for about 22-29% of acute intracranial hematomas, most of which can be diagnosed and treated with certainty on the first CT scan after injury. However, some EDH manifests progressively, especially those occurring after the first postoperative procedure after injury, which often affects the prognosis of injured patients if not diagnosed in a timely manner (1-11). In this paper, a retrospective review of 34 cases of postoperative traumatic progressive epidural hematoma (TPEDH) after craniocerebral trauma was conducted to discuss their clinical characteristics and early diagnosis and treatment experience. 1.1 Data and methods 1.1 Inclusion criteria Those who underwent craniotomy to remove the hematoma or/and debridement surgery after injury because of intracranial hemorrhage or/and open injury, confirmed by postoperative re-CT scan or/and surgery, and no hemorrhage on the first CT scan; or those who saw a small amount of EDH (<15ml supratentorial and <10ml infratentorial) hemorrhage enlargement (hemorrhage increase ≥25%) on the first CT scan after injury. 1.2 General data The group consisted of 25 males and 9 females; age: 2 to 69 years old, mean age 38.2±14.3 years old; cause of injury: 26 cases of car accident, 6 cases of fall injury, 2 cases of percussion injury; site of impact: 3 cases of frontal, 9 cases of temporal top, 17 cases of occipital top, 5 cases of occipital. Glasgow coma score (GCS) at admission: 3-5 points in 9 cases, 6-8 points in 16 cases, 9-12 points in 4 cases, and 13-14 points in 5 cases. 1.3 First post-injury CT scan and initial surgical findings Time from injury to first CT scan: within 1-20 h, mean 2.7±3.3 h. First CT findings: unilateral frontotemporal subdural hematoma (SDH) in 14 cases, bilateral frontotemporal SDH in 1 case, unilateral frontotemporal SDH with intracerebral hematoma (ICH) in 8 cases, unilateral ICH in 2 cases, and unilateral EDH in 7 cases. There were 7 cases of unilateral EDH, 2 cases of frontotemporal SDH on one side and EDH on the contralateral temporoparietal side. Three cases were treated conservatively after admission, and emergency surgery was performed after CT review within 6 h to confirm hematoma enlargement; the remaining 31 cases were operated immediately after admission. There were 30 cases of unilateral craniotomy and 4 cases of bilateral craniotomy. 1.4 The main manifestations of TPEDH at the time of diagnosis In addition to the two early cases in this group, which were diagnosed at 21 and 7 days after surgery, the rest were diagnosed at 3-24 h (mean 9.7±6.9 h) after surgery. The main manifestations at the time of diagnosis were: no significant improvement of postoperative consciousness disorder in 12 cases, once improved and then worsened in 6 cases, new neurological symptoms and signs in 7 cases, decompression window expansion in 2 cases, no clinically significant changes, and routine CT scan review 6 h after surgery to confirm the diagnosis in 7 cases. 1.5 Final treatment methods and results According to the location of TPEDH and the first craniotomy, the cases were divided into adjacent type (the edge of TPEDH was within 5 cm from the first craniotomy window) and distant type (the TPEDH was on the opposite side of the surgery area, or the edge of the hematoma was beyond 5 cm from the first craniotomy window). There were 8 cases of the adjacent type and 26 cases of the distal type. Among the distal type, 3 cases were ipsilateral, 19 cases were contralateral, and 4 cases were bilateral. location of TPEDH: among the unilateral cases, 2 cases were frontal, 1 case was temporal, 13 cases were parietal temporal, 12 cases were occipital, and 2 cases were above and below the transverse curtain; among the bilateral cases, 1 case was occipital, and 3 cases were occipital parietal and contralateral parietal temporal. In this group, 33 cases were operated again to remove the hematoma, and 32 cases were seen to have fracture at the site of hematoma intraoperatively, 29 cases had clear source of bleeding, and all of them had bleeding at the plate barrier of fracture, including 3 cases with combined venous sinus bleeding and 4 cases with combined arterial bleeding; the volume of hematoma: 28 cases with 20-50 ml and 5 cases with >50 ml. The hematoma was stabilized and gradually absorbed after bilateral decompression surgery in one case treated conservatively. There were 8 cases of death in this group, with a morbidity and mortality rate of 23.5%; causes of death: 5 cases of brainstem failure, 2 cases of multi-organ failure, and 1 case of pneumonia. The remaining patients were hospitalized for 17-96 days (mean 24.8±20.3), and the results of Glasgow Outcome Scale (GOS) score at discharge: 12 cases with 5, 8 cases with 4, 6 cases with 3, and 8 cases with 1. 2, Discussion, Theory Clinical studies have found that 35% to 65% of patients after craniocerebral trauma have worsening progressive clinical manifestations due to secondary cerebral ischemia, hemorrhage and edema. Among them, progressive hemorrhagic injury (PHI), which increases the risk of clinical deterioration by 5 times, is the main cause of disability and death in patients with craniocerebral trauma. Postoperative TPEDH is one of the major factors affecting the prognosis of patients, and early diagnosis and timely management will significantly improve the outcome of injured patients. 2.1 Clinical characteristics Reviewing the literature and combining the data of our group, we summarize the following clinical characteristics of postoperative TPEDH: 1. It mainly occurs at the site of trauma, with temporoparietal, occipitoparietal, occipital and frontal areas, different from acute EDH, which is mostly located in the temporal area; 83.4% of our group occurs in the temporoparietal and occipitoparietal areas; 2. In this group, only one case did not see any fracture; 4. Venous hemorrhage was the main cause, mainly bleeding from the plate barrier at the fracture site, venous sinus bleeding, and a few arterial bleeding (only four cases in this group); 5. The clinical manifestations were diverse, and the absence of postoperative consciousness or the deterioration of consciousness at one time and the appearance of new neurological deficits were the main clinical manifestations; some patients may have no obvious clinical changes after surgery, and were found by routine CT review; 6. Most of them occurred after surgery for SDH or/and intracerebral hematoma at the hedging site, and the most common occurred within 12 hours after surgery; except for two cases with subacute diagnosis in the early stage, the rest were clearly diagnosed within 12 hours after surgery in this group. 2.2 The prognosis of postoperative TPEDH is closely related to whether it can be diagnosed early and treated promptly. Comparative observation of neurological status before and after surgery is an important method for early detection of TPEDH, and quantitative assessment of consciousness status is particularly important. In addition, continuous ICP monitoring after injury can determine the development of intracranial hematoma and edema at the time of craniocerebral injury in a timely manner before clinical symptoms; if ICP >2.7 kPa is found, CT should be reviewed promptly after excluding external factors such as airway obstruction, agitation, and improper body position. Dynamic CT follow-up should be one of the important methods for early detection of TPEDH, but when to review CT is There is no uniform standard. Based on the retrospective summary of early cases, we propose a CT follow-up protocol for early diagnosis of postoperative TPEDH: 1. In the first craniotomy, after removal of hematoma and decompression, the tension of brain tissue is relatively high, and CT review is performed immediately after surgery to clarify the diagnosis and deal with it accordingly; 2. If the decompression of brain tissue is satisfactory after removal of hematoma, and new neurological deficits appear after surgery, CT review of the head is performed immediately; 3. If the decompression effect of brain tissue is satisfactory after hematoma removal and new neurological deficits appear after surgery, CT review of the head should be performed immediately; 3. 2.3. Treatment and prognosis EDH hematoma is usually absorbed slowly, and for those with occupying effect, early surgery should be performed to remove the hematoma. In addition to the severity of brain injury, the main factor affecting the prognosis is also closely related to whether the diagnosis can be made early. Among the 8 cases of death in this group, 6 were early cases with relatively late diagnosis; the other 2 cases had been brain herniated for too long (>3h) when they came to the clinic. In the last 3 years, due to routine postoperative CT follow-up examinations within 6 h, all patients were diagnosed and disposed of relatively early before the hematoma caused severe compression damage, and no new deaths occurred.