Epidural hematomas of the posterior cranial fossa

Bor-Seng-Shu, Edson; Aguiar, Paulo Henrique Pires de; Leme, Ricardo José de Almeida; Mandel, Maurício; Andrade, Almir Ferreira de; Marino, Raul

doi:10.3171/foc.2004.16.2.10

Cited by 39 publications

(44 citation statements)

References 24 publications

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“…Evolution over time influences the treatment of EDH significantly. We believe that CT scan of head should be done routinely in suspected case as early diagnosis of EDH is mandatory for good recovery as radiological changes always occur earlier than clinical changes and should be monitor to predict the clinical progression (4,5,29).…”

Section: Discussionmentioning

confidence: 99%

Extradural haematoma in children: surgical experiences and prospective analysis of 170 cases

Km²,

Mahmood³

et al. 2011

Turkish Neurosurgery

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AIm: We present our experiences in the management of extradural haematoma in children which involved an aggressive diagnostic approach, prompt surgical evacuation results in an excellent outcome. mAterIAl and methOds: 170 EDH patients who underwent surgery in our department from January 2006 to July 2010 included in this prospective study. Each patient evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome.results: Out of 170 cases 72%, (n=122) were boys and 28 %,( n=48) were girls. The boys to girls ratio was 2.54: 1. Age ranged from 1.8 to 18 years with a mean age of 9.49 years. Most of the victims are in the 11-18 years age group 44% ( n=74). The most common mode of injury was fall 41%, (n = 70) followed by Road traffic Accident (RTA) 32%, (n = 54) .The most common clinical presentation was altered sensorium 61 %, (n= 104), followed by headache and/or vomiting 56 %, (n = 96). The mortality rate was 8%.COnClusIOn: EDH is recognized as one of the most rewarding neurosurgical emergencies. It must be diagnosed in the early period of the trauma and evacuated early to prevent potential mortality and morbidity. Different factors affect the outcome of extradural haematoma Surgery including age of the patient, presence of cranial fractures, associated brain lesions and pre-operative neurological condition of patient, duration of time interval between onset of coma and surgical intervention. Better prognosis is seen in patients less than 10 years of age. sOnuÇ: Beyin cerrahisi acil yaklaşımları içerisinde en yüzgüldürücü sonuçları olan patolojilerden birisi de ekstradural hematomlardır. Bu tür hematomlar travmanın erken döneminde tanınmalı ve cerrahi tedavisi mortalite ve morbiditeyi önlemek için en hızlı şekilde yapılmalıdır. Ekstradural hematomların cerrahi sonuçları değişik faktörler tarafından etkilenmektedir; bunlar, hastanın yaşı, kranial kemik kırıklarının olması, beyinde ek lezyonların olması, hastanın ameliyat öncesi klinik durumu ve hastanın komaya giriş süresi ile ameliyata alınış süresi arasında geçen süre gibi etkenler sayılabilir. Yaşı 10'dan küçük olan hastaların prognozu daha iyi olmaktadır.

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Section: Discussionmentioning

confidence: 99%

Extradural haematoma in children: surgical experiences and prospective analysis of 170 cases

Km²,

Mahmood³

et al. 2011

Turkish Neurosurgery

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“…Radiological examinations should be judiciously used for identifying such lesions. Reliance on clinical findings alone is not recommended as these are nonspecific, and for all suspicious cases, it is advisable to conduct a CT scan to rule out these lesions [2,4,5]. Treatment is urgent surgical evacuation, except occasionally, when it consists of management along conservative lines [1,2].…”

Section: Introductionmentioning

confidence: 99%

Traumatic Pediatric Posterior Fossa Extradural Hematomas: A Tertiary-Care Trauma Center Experience from India

et al. 2015

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Introduction: Traumatic posterior fossa extradural hematomas (PFEDH) are rare lesions constituting <10% of all extradural hematomas. Reliance on clinical findings alone is not recommended as these are nonspecific; for all suspicious cases, it is advisable to conduct a CT scan. Only a handful of pediatric studies have been reported analyzing the outcome of such lesions. The aim of our study was to analyze outcomes for children with PFEDH managed at our apex trauma center. Materials and Methods: We conducted a retrospective analysis of pediatric patients (≤18 years) admitted with a diagnosis of traumatic PFEDH from January 2008 to February 2014. Results: Of 22 patients, 16 were managed surgically (group 1) and 6 conservatively (group 2); 1 failed conservative treatment (due to an increased EDH volume). Mean age was 11.7 years (range 2-18 years). Falls were the most common cause of injury. Vomiting and loss of consciousness were the most frequent presenting features. There were 18 mild, 2 moderate and 2 severe head injuries. The mean volume of EDH was 37.1 ml (range 18-100 ml) and 10.3 ml (8-16 ml) in the operative and conservative subgroups, respectively. Occipital bone fracture was seen in 16 cases with supratentorial extension in 11. Four complications were noted in 3 cases. Mean follow-up duration was 25.1 months (range 3-34 months). Except for 1 patient, all had excellent outcomes. There was no mortality. Conclusions: Traumatic pediatric PFEDHs are rare. Both the clinical status of the patient and the volume of the hematoma need to be assessed before deciding on surgery. Most cases have associated occipital bone fractures and around half have supratentorial extension; these need to be carefully assessed preoperatively. Torrential venous bleeding can be a major problem due to rupture of the adjacent sinuses. Timely intervention is crucial for achieving good outcome, keeping in view a low threshold for surgical evacuation. Although not innovative, this second-largest case series provides additional data and contributes to the existing literature on such lesions in pediatric patients.

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“…The main clinical manifestations of SIEDH are headache, vomiting, neck resistance, and lack of the typical signs of nervous system orientation. The condition may rapidly deteriorate, causing compression of the transverse sinus and brain stem and subsequently death of the patient (1)(2)(3)(4)(5)(6)(7)(8)(9). This type of epidural hematoma mainly occurs due to occipital deceleration injury, most often associated with occipital bone fracture or lambdoid suture separation (3)(4).…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of supra- and infratentorial epidural hematoma

Wang

Li²

2011

Turkish Neurosurgery

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Supra-and infratentorial acute epidural hematoma (SIEDH) is a common type of posterior fossa epidural hematoma (PFEDH), representing 11-64% of all PFEDHs. Although SIEDH is associated with typical characteristics, it might be difficult to diagnose when presenting as infratentorial acute epidural hematoma, which is clinically silent and has nonspecific symptoms. However, this type of hematoma can often be rapidly deteriorating, causing a sharp rise in intracranial pressure that leads to a life-threatening foramen magnum herniation. Early diagnosis and management of SIEDH are imperative. Traditional surgical management has always required relatively large craniotomies, larger than the hematoma itself, to expose its edge, and then tack up the dura matter). It usually opens the window and emphasizes retention of the bone bridge outside the transverse sinus. This method can effectively eliminate the hematoma, but it is associated with larger postoperative wound, longer operation time, larger skull defect, and more complications. Hence, exploration into a better surgical method is direly needed.

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Epidural hematomas of the posterior cranial fossa

Cited by 39 publications

References 24 publications

Extradural haematoma in children: surgical experiences and prospective analysis of 170 cases

Extradural haematoma in children: surgical experiences and prospective analysis of 170 cases

Traumatic Pediatric Posterior Fossa Extradural Hematomas: A Tertiary-Care Trauma Center Experience from India

Surgical treatment of supra- and infratentorial epidural hematoma

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