Epidural hematoma in children: do cranial sutures act as a barrier?

OBJECTIVES: Epidural hematoma (EDH) is secondary to laceration of meningeal vessels (arteries or veins), diploic veins or dural sinuses in head injuries. It is widely believed that EDH does not cross cranial sutures, allowing its differentiation from subdural hematoma (SDH). The goal of this study was to determine the percentage of EDH that crosses cranial sutures.

METHODS: Fifty-seven children with at least one EDH lesion were included in the study. CT examination was performed in all patients using a spiral CT scanner and a dedicated children's protocol. The number, location and size of EDH and their anatomical relationship to cranial sutures were analyzed by consensus between two radiologists.

RESULTS: Retrospective data analysis showed that, in 11% of children, EDH crossed cranial sutures. Factors that may explain suture crossing are fractures traversing cranial sutures and posttraumatic cranial suture diastasis.

CONCLUSION: Our study showed that hematoma extending across a suture may not always allow differentiation between EDH and SDH.