Acute peritentorial subdural hematoma (APSDH) is an extremely rare intracranial bleeding, which generally occurs due to a trauma. And, It usually regresses spontaneously without the need for a surgical intervention. However, it is difficult to determine the surgical method when it is life-threatening.
A 15-year-old boy was brought to the hospital after a crash with a car whilst on a motorcycle. No significant intracranial bleeding was detected following an isolated severe head trauma; however, Glasgow Coma Score was 8 due to the serious cerebral edema. Uncal herniation and anisocoria were detected 6 hours later. The brain tomography scan was repeated and a hematoma was detected on the surface of the tentorium. Stopping the herniation was necessary. The patient underwent decompressive temporo-parietal craniectomy, duraplasty and extensive in order to access the base of the brain.
Herniation was stopped and peritentorial blood spontaneously reduced. APSDH usually does not exert a significant mass effect alone. If it co-exist with severe cerebral edema, it may be cause to cerebral herniation. The extensive cranial decompression surgery was performed on the skull base. Although it was the indirect surgical approach, Decreased peritentorial bleeding volume was detected following the surgery. This result is not the expected. But, There is proof that how flexible and strong pulsations of his the brain tissue in a young man with intracranial hypertension.
No direct surgical intervention could be performed in the presence of a life-threatening by bleeding in a hard-to-reach area. Although direct surgery for hematoma is not performed, the primary aim is to urgently prevent cerebral herniation. We were thinking that this method for a bleeding in peritentorial localization can be applied.