title: Traumatic Frontal Epidural Hematoma Caused by Multiple Arterial Injuries in the Anterior Fossa.
abstract: BACKGROUND
  This case report illustrates the need to evaluate the possibility of multiple arterial sources when presented with a frontal epidural hematoma associated with facial trauma.
  
  
  METHODS
  The patient presented after being struck in the face by a baseball. Computed tomography of the brain revealed a large frontal epidural hematoma. Intraoperatively, bleeding from a frontal branch of the middle meningeal artery was encountered and cauterized, and the hematoma was removed. Routine follow-up imaging performed the next day showed a residual frontal hematoma; however, the epidural hematoma was in a more medial location than the initial hematoma. The patient was taken back to the operating room; after frontal lobe retraction and extensive exploration, a different source of bleeding from posterior ethmoidal artery feeders was encountered. After the second operation, the patient's hematoma did not recur, and he was discharged home with no neurologic deficits 3 days later.
  
  
  CONCLUSIONS
  We report a case of an epidural hematoma caused by 2 distinct arterial feeders. We discuss radiologic review and operative management of anterior fossa epidural hematomas and stress the importance of considering arterial bleeding from sources other than the middle meningeal artery in anterior fossa epidural hematomas. We discuss the utility of preoperative angiography for these patients and reinforce the need for acute postoperative imaging to ensure successful operative and patient outcomes.
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine, Davie, Florida, USA.
authors.forename: J Willis
authors.initials: JW
authors.lastname: Kiessling
authors.affiliation: Division of Pediatric Neurosurgery, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA.
authors.forename: Dean A
authors.initials: DA
authors.lastname: Hertzler
authors.affiliation: Division of Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA.
authors.forename: David E M
authors.initials: DE
authors.lastname: Drucker
authors.affiliation: Division of Pediatric Neurosurgery, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA. Electronic address: hspader@mhs.net.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Spader
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D003388:Cranial Fossa, Posterior / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male
keywords: Anterior fossa; Epidural; Ethmoid artery; Pediatric