Extradural hematoma of the posterior cranial fossa

Report of seven cases with survival

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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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Address reprint requests to: Román Garza-Mercado, M.D., Aleutianas 396, Col. V. Hermosa, Monterrey, Nuevo León, México.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 2. Plain skull film, submentovertical view, showing a linear fracture extending from the area of the transverse sinus to the petrous bone in the left posterior fossa.

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    Case 3. Computerized tomography scan showing a biconvex collection with the density of blood in the left posterior fossa.

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    Case 4. Computerized tomography scan showing a lenticular collection of mixed density in the region of the left transverse sinus. The shadow of the fourth ventricle is displaced forward and slightly to the right of the midline.

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    Case 5. Conray ventriculograms. Left: Lateral view showing the contrast medium in the cisterna magna separated from the inner table of the skull in the posterior fossa (arrow). The fourth ventricle is displaced ventrally, and there is mild ventricular dilatation. Right: Towne view showing displacement of the fourth ventricle to the left of the midline. Notice the diagonal linear fracture across the sulcus of the transverse sinus in the right occipital bone (retouched).

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    Case 6. Computerized tomography scan showing a slightly hyperdense lenticular lesion of the left posterior fossa.

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    Case 7. Skull x-ray films, Towne view. A linear fracture extends from the inion into the right petrous bone (retouched).

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