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      <h1 class="highwire-cite-title" id="page-title">Predictive Value of Calvarial Fracture for Delayed Epidural Hematoma following Decompressive Craniectomy</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Q.-p. Wang</span> and <span class="highwire-citation-author" data-delta="1">C. You</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2015,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E24; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4216 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14001--61766316701" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Q.-p. Wang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Neurosurgery
West China Hospital
Sichuan University
Chengdu, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Neurosurgery
Dujiangyan People's Hospital
Dujiangyan Medical Center
Dujiangyan, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Q.-p.%2BWang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wang%20Q&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AQ.-p.%2BWang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">C. You </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Neurosurgery
West China Hospital
Sichuan University
Chengdu, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BYou%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=You%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.%2BYou%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We read with great interest the article by Talbott et al<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> describing the predictive value of patterns of skull fractures on preoperative CT for delayed epidural hematoma. Although we agree with the principal findings of the study, we would like to clarify some important clinical points to further increase the practical value of the article. First, the authors stated that all patients developing a delayed epidural hematoma had a contralateral calvarial fracture on preoperative CT at the site where the delayed epidural hematoma subsequently formed. It is incontrovertible that almost all traumatic epidural hematomas are accompanied by skull fractures; however, there are still some patients with traumatic epidural hematoma without skull fracture or in whom the fracture cannot be detected by CT.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> Therefore, we think that the contralateral calvarial fracture could not have perfect sensitivity (100%) for subsequent development of delayed epidural hematoma as stated by the authors.</p><p id="p-2">Second, epidural hematomas mainly occur due to injuries of blood vessels under the bone, so calvarial fractures near blood vessels are apt to cause epidural hematoma. Therefore, we think that the location of the fracture might be more important than fractures involving 2 or more bone plates, an idea strongly supported by the authors. Last, although the sensitivity was 100% according to the article, only 12 of all 55 patients with contralateral calvarial fracture developed delayed epidural hematoma. We admit that the presence of a calvarial fracture contralateral to the anticipated side of craniectomy has a higher risk of delayed epidural hematoma, but it may not be the only clue. Are there some other factors that could help make a more accurate judgment? More large and well-conducted clinical trials may be required to address this issue.</p><div class="section ref-list" id="ref-list-1"><h2 class="">REFERENCES</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

<div class="cit ref-cit ref-journal" id="cit-36.3.E24.1" data-doi="10.3174/ajnr.A4001"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Talbott</span>  <span class="cit-name-given-names">JF</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Gean</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Yuh</span>  <span class="cit-name-given-names">EL</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Calvarial fracture patterns on CT imaging predict risk of a delayed epidural hematoma following decompressive craniectomy for traumatic brain injury</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2014</span>;<span class="cit-vol">35</span>:<span class="cit-fpage">1930</span>–<span class="cit-lpage">35</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czoxMDoiMzUvMTAvMTkzMCI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8zNi8zL0UyNC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a>

<div class="cit ref-cit ref-journal" id="cit-36.3.E24.2" data-doi="10.1097/TA.0b013e31815885d9"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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