Extradural hemorrhage (venous)

Last revised by Mohamed Saber on 22 Feb 2021

Venous extradural hemorrhages are a relatively uncommon subtype of extradural hemorrhages, differing from arterial extradural hemorrhages not only in etiology, but also location and prognosis. 

They occur as a result of damage to the dural venous sinuses and often result in the displacement of the sinus away from the underlying bone. 

For a general discussion, including epidemiology, clinical presentation, pathophysiology and general imaging appearances, please refer to the article on extradural hemorrhage. 


Three locations are characteristic of venous extradural hemorrhage:

  1. vertex
  2. anterior middle cranial fossa
  3. occipital posterior fossa

Extradural hemorrhages located at the vertex are usually due to diastasis +/- fracture involving the superior sagittal sinus. Venous blood from the sinus or closely associated vein accumulates between the endosteal layer of the dura and the overlying inner table of the skull. Because the sinus runs in line with the disrupted sagittal suture, this is one of the occasions when an extradural hematoma crosses the suture and in so doing displaces the superior sagittal sinus inferiorly. 

Anterior middle cranial fossa

Anterior middle cranial fossa extradural hemorrhages are thought to arise from the sphenoparietal sinus which runs along the superior margin of the greater wing of sphenoid 1. Due to their location, the anatomy of dural attachments and venous origin, they do not cause midline shift or herniation, rarely grow, and can generally be managed conservatively 1

Occipital posterior fossa

Although most extradural hematomas in the posterior fossa are due to temporal bone fractures involving the middle meningeal artery, in the setting of occipital trauma, particularly fractures of the occipital bone, venous hemorrhage is more common 2. As is the case with vertex extradural hemorrhages, bleeding is from the adjacent sinus, in this case, the transverse sinus, which can be elevated away from the underlying bone. 

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