Posterior fossa epidural hematomas in children: clinical experience with 40 cases

Clinical article

Restricted access

Object

Traumatic posterior fossa epidural hematoma (PFEDH) is rare, but among children it may have a slightly higher incidence. With the widespread use of CT scanning, the diagnosis of PFEDH can be established more accurately, leading to an increased incidence of the lesion and possibly to a better patient prognosis. This study presents 40 pediatric cases with PFEDH.

Methods

The authors assessed the type of trauma, clinical findings on admission, Glasgow Coma Scale scores, CT findings (thickness of the hematoma, bone fracture, compression of the fourth ventricle, and ventricle enlargement), type of treatment, clinical course, and prognosis. Early postoperative CT scans (within the first 6 hours) were obtained and reviewed in all surgical cases.

Results

Twenty-nine patients underwent surgery and 11 patients received conservative therapy and close follow-up. All patients fared well, and there was no surgical mortality or morbidity.

Conclusions

Based on the data in this large series, the authors conclude that PFEDH in children can be treated in experienced centers with excellent outcome, and there is no need to avoid surgery when it is indicated.

Abbreviations used in this paper:GCS = Glasgow Coma Scale; PFEDH = posterior fossa epidural hematoma; SAH = subarachnoid hemorrhage.

Article Information

Address correspondence to: Mehmet Osman Akcakaya, M.D., Department of Neurosurgery, Istanbul Universitesi Istanbul Tıp Fakultesi Norosirurji Anabilim Dalı, Norolojik Bilimler Binası 6.kat Çapa/Fatih/İstanbul 34093, Turkey. email: moakcakaya@gmail.com.

Please include this information when citing this paper: DOI: 10.3171/2011.11.PEDS11177.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Preoperative CT scans revealing a large PFEDH in a 14-year-old boy, displacing the fourth ventricle and causing ventriculomegaly.

  • View in gallery

    Postoperative CT scans obtained in the same patient in Fig. 1.

  • View in gallery

    Admission (left) and 48-hour postadmission (right) CT scans acquired in an 8-year-old boy with conservatively managed PFEDH.

References

1

Ammirati MTomita T: Posterior fossa epidural hematoma during childhood. Neurosurgery 14:5415441984

2

Asanin B: Traumatic epidural hematomas in posterior cranial fossa. Acta Clin Croat 48:27302009

3

Berker MCataltepe OOzcan OE: Traumatic epidural haematoma of the posterior fossa in childhood: 16 new cases and a review of the literature. Br J Neurosurg 17:2262292003

4

Bor-Seng-Shu EAguiar PHde Almeida Leme RJMandel MAndrade AFMarino R Jr: Epidural hematomas of the posterior cranial fossa. Neurosurg Focus 16:2ECP12004

5

Bozbuğa MIzgi NPolat GGürel I: Posterior fossa epidural hematomas: observations on a series of 73 cases. Neurosurg Rev 22:34401999

6

Bullock MRChesnut RGhajar JGordon DHartl RNewell DW: Surgical management of posterior fossa mass lesions. Neurosurgery 58:3 SupplS47Siv2006

7

Ciurea AVNuteanu LSimionescu NGeorgescu S: Posterior fossa extradural hematomas in children: report of nine cases. Childs Nerv Syst 9:2242281993

8

Costa Clara JMClaramunt ELey LLafuente J: Traumatic extradural hematomas of the posterior fossa in children. Childs Nerv Syst 12:1451481996

9

Dhellemmes PLejeune JPChristiaens JLCombelles G: Traumatic extradural hematomas in infancy and childhood. Experience with 144 cases. J Neurosurg 62:8618641985

10

Dirim BVOrük CErdoğan NGelal FUluç E: Traumatic posterior fossa hematomas. Diagn Interv Radiol 11:14182005

11

Ersahin YMutluer S: Posterior fossa extradural hematomas in children. Pediatr Neurosurg 19:31331993

12

Frush DPSoden BFrush KSLowry C: Improved pediatric multidetector body CT using a size-based color-coded format. AJR Am J Roentgenol 178:7217262002

13

Hayashi TKameyama MImaizumi SKamii HOnuma T: Acute epidural hematoma of the posterior fossa—cases of acute clinical deterioration. Am J Emerg Med 25:9899952007

14

Jang JWLee JKSeo BRKim SH: Traumatic epidural haematoma of the posterior cranial fossa. Br J Neurosurg 25:55612011

15

Karasu ASabanci PAIzgi NImer MSencer ACansever T: Traumatic epidural hematomas of the posterior cranial fossa. Surg Neurol 69:2472522008

16

Lui TNLee STChang CNCheng WC: Epidural hematomas in the posterior cranial fossa. J Trauma 34:2112151993

17

Malik NKMakhdoomi RIndira BShankar SSastry K: Posterior fossa extradural hematoma: our experience and review of the literature. Surg Neurol 68:1551582007

18

Mohanty AKolluri VRSubbakrishna DKSatish SMouli BADas BS: Prognosis of extradural haematomas in children. Pediatr Neurosurg 23:57631995

19

Mori KHanda HMunemitsu HOda YHashimoto NKojima M: Epidural hematomas of the posterior fossa in children. Childs Brain 10:1301401983

20

Peter JCDomingo Z: Subacute traumatic extradural haematomas of the posterior fossa: a clinicopathological entity of the 5- to 10-year-old child. Childs Nerv Syst 6:1351381990

21

Pozzati ETognetti FCavallo MAcciarri N: Extradural hematomas of the posterior cranial fossa. Observations on a series of 32 consecutive cases treated after the introduction of computed tomography scanning. Surg Neurol 32:3003031989

22

Roda JMGiménez DPérez-Higueras ABlázquez MGPérez-Alvarez M: Posterior fossa epidural hematomas: a review and synthesis. Surg Neurol 19:4194241983

23

Scaife ERRollins MD: Managing radiation risk in the evaluation of the pediatric trauma patient. Semin Pediatr Surg 19:2522562010

24

Singh SKalra MKMoore MAShailam RLiu BToth TL: Dose reduction and compliance with pediatric CT protocols adapted to patient size, clinical indication, and number of prior studies. Radiology 252:2002082009

25

Stone JLSchaffer LRamsey RGMoody RA: Epidural hematomas of the posterior fossa. Surg Neurol 11:4194241979

26

Wong CW: The CT criteria for conservative treatment—but under close clinical observation—of posterior fossa epidural haematomas. Acta Neurochir (Wien) 126:1241271994

27

Zuccarello MAndrioli GCFiore DLLongatti PLPardatscher KZampieri P: Traumatic posterior fossa haemorrhage in children. Acta Neurochir (Wien) 62:79851982

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 65 65 18
Full Text Views 70 70 3
PDF Downloads 105 105 3
EPUB Downloads 0 0 0

PubMed

Google Scholar