Epidural hematoma at the base of the middle cranial fossa is less common, and the amount of hematoma is relatively small. It is often overlooked because of the early clinical and CT manifestations are mild or atypical, but it can lead to serious consequences as the disease progresses, such as the increase of hematoma and the increase of brainstem compression (further compression of the cricoid pool). The epidural hematoma at the base of the middle cranial fossa (due to its location) has the following characteristics: 1. Early clinical manifestations can be mild, without obvious intracranial hypertension manifestations and neurological deficits; the degree of consciousness impairment is mild, and the GCS score is greater than 8. 2. The epidural hematoma at the base of the middle cranial fossa is adjacent to the fissure of the cerebellar curtain, which can easily produce compression on the temporal lobe and brainstem, and a relatively small amount of hematoma can cause brainstem compression or temporal lobe herniation. In early stage, when the brainstem is mildly compressed, the brainstem reticular function is not yet significantly affected, so the degree of consciousness impairment can be mild; with the formation of temporal lobe hook gyrus herniation, the aggravation of brainstem compression and the rapid increase of intracranial pressure caused by the obstruction of cerebrospinal fluid circulation due to basal pool occlusion, the condition can be gradually aggravated or even rapidly deteriorated. 4. Estimation of hematoma volume: Due to the special structure of the middle cranial fossa and the partial volume effect of CT examination, the value calculated according to Tada’s formula is often less than the actual hematoma volume. In the future, a more accurate estimation of the volume of the middle cranial fossa hematoma can be made by rapid cranial MRI scan. 5. Change in the shape of the cricoid pool: Epidural hematoma at the base of the middle cranial fossa easily causes compression or occlusion of the cricoid pool. The change of cricoid pool morphology indirectly reflects the degree of brainstem damage and severity of the disease, and affects the prognosis. Conservative treatment is less effective, and the state of consciousness improves rapidly after timely surgery. Treatment of epidural hematoma at the base of the middle cranial fossa For those who have mild post-injury impairment of consciousness, small hematoma at the base of the middle cranial fossa and CT shows no obvious occupying effect and no (or only partial) compression of the cricoid pool, conservative treatment should be performed cautiously under CT dynamic monitoring in combination with clinical manifestations. Once progressive impairment of consciousness, alteration of neurological signs and aggravation of cricoid pool compression are detected, surgical treatment should be actively taken to avoid losing time and delaying treatment; even if the clinical symptoms improve after conservative treatment and the cricoid pool is still progressively compressed or occluded, surgical treatment should be actively taken. The morphological changes of the cricoid pool should be considered as an important objective indicator to indicate the disease and decide whether to operate or not. There is a close intrinsic relationship between the deterioration of the patient’s condition and the compression of the cricoid pool, and all such patients should be operated early and actively.