Calvarial Fracture Patterns on CT Imaging Predict Risk of a Delayed Epidural Hematoma following Decompressive Craniectomy for Traumatic Brain Injury

DEDH following decompressive hemicraniectomy for traumatic brain injury. A, Axial noncontrast CT at the level of the corona radiata before initial decompression demonstrates diffuse effacement of the cerebral sulci and small holohemispheric subdural hematoma on the left. Small bilateral frontal hemorrhagic contusions and scattered subarachnoid hemorrhage were also present. B, Three-dimensional volume-rendered image reconstructed from bone algorithm noncontrast head CT demonstrates complex calvarial fractures on the right involving the right temporal, occipital, and parietal bones. C, Noncontrast head CT performed after left decompressive hemicraniectomy shows interval development of a new, large, heterogeneously attenuated epidural hematoma in the right parietal region with new right to left midline shift and left frontotemporal external herniation.