Traumatic Posterior Fossa Hematoma, A Rare Entity: Study of 21 Cases (original) (raw)
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Acta Neurochirurgica, 2014
Background Traumatic posterior fossa subdural hematomas (SDHs) are rare lesions. Despite improvements in intensive care and surgical management of traumatic brain injuries over the last decades, the outcome for posterior fossa subdural hematomas remains poor. Methods We conduct a retrospective study over a 2-year period of patients sustaining traumatic brain injury and posterior fossa SDH. Additionally, a systematic review of case series published to date was performed. Results The incidence of posterior fossa SDH was 0,01 % (4/326). All patients in this current series had poor prognosis. Three out of four exhibited ischemic/edema lesions in postoperative CT scans leading to fourth ventricle effacement and persistent brainstem compression. Our literature review retrieved 57 patients from only seven case series. Unfavorable outcomes were seen in 63 % of patients. Conclusions Our data and data from the literature do not provide sufficient evidence to establish an optimal treatment strategy for posterior fossa SDH. However, based on lessons learned with these four cases, together with results from review of the literature, we propose an algorithm for the management of this rare condition.
Traumatic posterior fossa extradural hematoma: Experience at level I trauma center
Asian journal of neurosurgery, 2018
Introduction: Posterior fossa extradural hematoma (PFEDH) is rare among the traumatic brain injury and represent about 4-7% cases of all EDHs. This rare condition is rapidly fatal unless identified and intervened timely. Because of limited space in posterior fossa, comparatively small volume can cause clinical deterioration. Early diagnosis by cranial computed tomography and emergent evacuation is vital for a good outcome. Materials and Methods: This study was conducted at Level I trauma center at All India Institute of Medical Sciences, New Delhi, India. Hospital medical records were reviewed from September 2007 to June 2015. There were 856 cases of acute EDHs and of these 69 cases had PFEDHs. Records of patients with PFEDHs were reviewed for the mode of injury, Glasgow Coma Scale (GCS) at admission, imaging, type of intervention, outcome, and follow-up. GCS was assessed at 6 months and 12 months follow-up. Pertinent literature is reviewed. Results: Of these 69 patients, 51 were males and 18 females. The mean age of patients was 28.6 years (range 4-43 years). Forty-three patients had GCS 15 at admission, and only 4 of them had admission GCS <8. Mean EDH volume was 29.2 ml. Sixty-six patients were operated, three managed conservatively. Sixty-seven patients were discharged, of which, 56 (81.1%) had GCS 15. Two patients died. Most common associated injuries were long bone fractures (18, 26.1%) followed by blunt injury thorax (11, 15.9%). Mean follow-up duration was 69.2 months (range 6-94 months). At 6 months follow-up, 61 (88.4%) patients had good recovery (Glasgow Outcome Score [GOS] 5) and at 12 months, 62 (89.8%) had GOS 5. Conclusion: PFEDH are rare. They are usually associated with occipital bone fractures and may also have a supratentorial hematoma. It may be rapidly fatal due to the expansion of hematoma and compromise of the posterior cranial fossa space leading to brainstem compression, tonsillar herniation, and/or obstructive hydrocephalus. Early diagnosis and emergent evacuation lead to good outcome.
Traumatic acute posterior fossa subdural hematoma – A case report and review of literature
Romanian Neurosurgery, 2014
Traumatic subdural hematomas of the posterior fossa are rare but dangerous neurosurgical emergencies that require prompt diagnosis and management to avoid the uniformly poor outcome. We present a case of a teenager with severe TBI and acute subdural hematoma of the posterior fossa that deteriorated rapidly before surgery but eventually made a good recovery. We also the review the literature concerning traumatic posterior fossa subdural hematomas [PFSDH].
Traumatic Epidural Hematoms in Posterior Cranial Fossa: a Clinical Study in Tertiary Care Hospital
2018
Objective: To determine clinical presentation and outcome of traumatic epidural hematoma in posterior cranial fossa. Material and Methods: This descriptive case series was conducted in department of Neurosurgery Mardan Medical Complex Mardan from May 2016 to April 2017. All patients presenting with extradural hematoma in posterior fossa of either gender and age were included in the study while patients with recurrent posterior fossa extradural hematoma and hematoma at other side of the brain were excluded. CT scan Brain with bone window was done in all patients. Patients were followed for one month. Outcome was measured on the basis of GCS and GOS. Results: Total 23 patients were included in the study having age range from 8 to 58 years with mean age was34 ± 5.23 years. 16 (69.56%) were males and 7 (30.4%) were female. Road traffic accident was the most common cause of head injury in 11 (47.8%) cases. Headache and vomiting was seen in 16 (69.5%) cases, drowsiness in 8 (33%), occipit...
Traumatic epidural hematomas of the posterior cranial fossa
Surgical Neurology, 2008
Object. The authors present their experience in the management of posterior fossa epidural hematoma (PFEDH), which involved an aggressive diagnostic approach with the extensive use of head computerized tomography (CT) scanning.
Traumatic extradural hematomas of the posterior fossa in children
Child S Nervous System, 1996
The most favorable type of traumatic intracranial bleeding in childhood is the extradural hemorrage (EDH). The posterior fossa location is less frequent than the supratentorial site. In the period from January 1989 to January 1994 we treated 2,372 patients with craniocerebral trauma; 31 had extradural hematomas (1.3%); 3 of them were located in the posterior fossa (9.7%): 1 boy and 2 girls aged from 6 to 16 years. The traumatic mechanism was an occipital fall in all cases. Diagnosis was made by computed tomography scan (CT). Two of them had a rapidly deteriorating course. The three patients were operated on without mortality and there was no morbidity. The role of CT in the early detection of lesions and prompt surgical evacuation may reduce the mortality and morbidity from this lesion. The interaction between these factors is discussed.
2016
Objective: To determine the clinical presentation and outcome of traumatic epidural hematoma in posterior fossa. Methodology: This observational study was conducted in Department of Neurosurgery Lady Reading Hospital, Peshawar from 30th November 2009 to 29th November 2014. We collected data for both operated and non-operated cases of traumatic posterior fossa epidural hematoma, of any gender and age. Patients were followed for 6 months and all the data was analyzed by SPSS version 20 and presented in figures. Results: Total 34 patients were included in the study having age range from 5-60 years with mean age of 32.5±16.24 years. Males were 25(73.52%) and females were 9(26.47%). The most common cause was motor vehicle accident found in 15(44%) cases. seventeen (50%) patients were managed conservatively, while 17(50%) were managed by surgery. Good outcome was found in 28(82.35%) and in remaining 6(17.64%) there was poor outcome. Conclusion: The frequency of posterior fossa epidural he...
Indian Journal of Neurotrauma, 2017
Introduction Posterior fossa extradural hematomas (PFEDH) comprise 4 to 7% of all intracranial extradural hematomas (EDHs). Material and Methods A prospective study of 25 patients who presented with PFEDH was conducted in PGIMER, Dr. Ram Manohar Lohia (RML) Hospital, New Delhi in department of neurosurgery from January 2011 to July 2012. The patients were analyzed in relation to age, sex, mode of injury, Glasgow coma scale (GCS) at the time of presentation, computed tomography findings of the head, and therapeutic outcome. Duration of follow-up was 6 months. Results In the authors’ study, male-to-female ratio was 22:3. Age range was 6 months to 62 years and mean age was 23.70 years. Mode of trauma was fall from height in 12 patients, road traffic accident (RTA) in 12, and assault in 1. Most patients had acute course (80%) followed by subacute course (20%). GCS was between 8 and 15. Fracture was associated in 21 patients out of 25. Associated intracranial injury was present in 22 pat...
Traumatic Posterior Fossa Epidural Hematomas (Travmatik Posterior Fossa Epidural Hematomları)
Objective : Epidural haematoma (EDH) most commonly occurs in the supratentorial area, particularly in the temporal region, of the brain. Posterior fossa epidural haematoma (PFEDH) is less frequently observed, accounting for only 1.2% to 12.9% of all EDH cases. Because of the non-specific symptoms and the potential for rapid and fatal deterioration in children, an early computed tomography (CT) scanning is necessary for all suspicious cases. The aim of the present study was to share the experience of 48 cases and review the literature concerning PFEDH. Methods : A retrospective analysis was conducted for 48 paediatric cases diagnosed with PFEDH and admitted to Yuying Children's Hospital of Wenzhou Medical University from January 2010 to August 2015. The clinical features and outcomes were analyzed and compared with previous literature. Results : Seventeen patients were surgically treated in this series and 31 patients received non-operative treatment. The outcomes were good in 46 patients, evaluated using the Glasgow outcome score (GOS), while mild disability was observed in one patient, and only one case showed severe disability. There were no cases of mortality in this series. Posterior fossa epidural haematoma is relatively rare compared with supratentorial epidural haematoma. Early and serial CT scans should be performed for all suspicious cases. The criteria for the surgical treatment of paediatric patients with PFEDH were concluded. The overall prognosis was excellent in paediatric patients.
Extradural hematomas of the posterior cranial fossa
Surgical Neurology, 1989
A series of 32 patients with posterior fossa epidural hematoma treated after the introduction of computed tomography scanning between 1975 and March 1988 is presented. Sixteen patients harbored "pure" epidural hematomas, whereas 16 had other infratentorial or supratentorial traumatic lesions. Glasgow Coma Scale on admission was 7 or less in 10 patients, 8-12 in 11, and 13-14 in 11. Only six patients had a lucid interval. Thirty patients were treated surgically; two patients with small hematomas were treated conservatively. Overall mortality was 15.6%, with 0% for "pure" and 31.2% for "complicated" posterior fossa epidural hematomas. The value of routine computed tomography scanning is emphasized in cases with occipital skull fracture or when such fracture is found in patients undergoing emergency evacuation of supratentorial hematomas. The pertinent literature is addressed with special regard to the delayed occurrence, associated lesions, and mortality of posterior fossa epidural hematomas and to the role of computed tomography scanning.