Extradural hematoma of the posterior cranial fossa

Report of seven cases with survival

Román Garza-Mercado Division of Neurological Surgery, Department of Surgery, Facultad de Medicina and Hospital Universitario, Universidad Autónoma de Nuevo León, and Hospital ISSSTE, Monterrey, Nuevo León, México

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✓ Extradural posttraumatic posterior fossa hematoma is a rare condition estimated to complicate about 0.3% of all craniocerebral injuries, and represents 4% to 12.9% of the entire group of extradural hematomas. Seven cases of posterior fossa extradural hematoma (PFEDH) are presented. There were four males and three females. One case occurred in an adult, the remaining six cases in patients 16 years of age or younger, two of whom were infants. In each case the hematoma resulted from a blow to the posterior part of the head. Each patient showed local evidence of trauma to the scalp, and a radiographic appearance of an occipital linear fracture crossing the path of the torcular Herophili or the transverse sinus. The clinical picture varied. Three patients suffered immediate transient unconsciousness. Three others suffered sudden respiratory arrest after a seemingly stable course of several hours in the hospital, but responded well to resuscitation maneuvers. Computerized tomography scans were obtained in three patients; in three others no specialized neurodiagnostic studies were feasible; in one patient, precise diagnostic documentation was achieved by Conray ventriculography. All seven patients were operated on and all survived. Two patients had associated surgical intracranial lesions: an underlying subdural hygroma of the posterior fossa in one, and a contralateral supratentorial temporal subdural hematoma in the other. Six patients have returned fully to their previous activities. One patient is steadily improving.

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