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

Sencer, Altay; Aras, Yavuz; Akçakaya, Mehmet; Göker, Burcu; Kırış, Talat; Canbolat, Ali

doi:10.3171/2011.11.peds11177

Cited by 36 publications

(92 citation statements)

References 25 publications

(50 reference statements)

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“…Although the EDH measurements were larger in the surgery cohort, there were several patients with normal mental status and large hematomas (>15 mm diameter) who were observed with good outcomes, indicating that EDH size alone should not dictate operative decision making. There has previously been concern that patients with EDH in the temporal or posterior fossa region are at higher risk for poor outcomes [14,17,18,19,20,21]. However, our observed population included 17 patients with EDH in the temporal region, further supporting the growing body of evidence that hematoma location should not be an absolute indication for surgery [22,23].…”

Section: Discussionmentioning

confidence: 43%

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Flaherty¹,

Loya²,

Alexander³

et al. 2013

Pediatr Neurosurg

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Background: There are currently no clear guidelines for the management and radiological monitoring of pediatric patients with epidural hematomas (EDH). We aim to compare clinical and radiographic characteristics of pediatric EDH patients managed with observation alone versus surgical evacuation and to describe results of repeat head imaging in both groups. Methods: We performed a retrospective observational study of pediatric patients diagnosed with traumatic EDH at a level II trauma center. Results: Forty-seven cases of EDH were analyzed. Sixty-two percent were managed by observation alone. Patients undergoing surgery were more likely to have an altered mental status (17 vs. 72%, p < 0.001), but there were no other significant clinical differences between the groups. The mean initial EDH thickness and volume were 8.0 mm and 8.6 ml in the observed group and 15.5 mm and 35 ml in the surgery group, respectively (p < 0.001 for both comparisons). Eighty-six percent of the observed and all surgery patients underwent repeat CT imaging. The initial repeat CT scan results led to surgery in 1 patient who was initially treated with observation. Conclusions: Most pediatric patients with EDH can be managed with observation. Mental status and radiographic findings should guide the need for surgical intervention. Multiple repeat CT scans have minimal utility in changing management.

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Section: Discussionmentioning

confidence: 43%

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Flaherty¹,

Loya²,

Alexander³

et al. 2013

Pediatr Neurosurg

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“…Treatment is urgent surgical evacuation, except occasionally, when it consists of management along conservative lines [1,2]. A few series have reported the outcomes of such traumatic lesions in children [1,2,3,6,7,8,9,10]. The aim of this study was to analyze the outcomes for children with PFEDH who were managed at our apex trauma center and to compare our results with published reports.…”

Section: Introductionmentioning

confidence: 94%

“…The most common location is the temporal region; posterior fossa location is rare, comprising only 1.2-12.9% of all EDH [1,2,3]. The incidence of traumatic brain injury is increasing in both developing and developed countries.…”

Section: Introductionmentioning

confidence: 99%

“…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%

“…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]. A few series have reported the outcomes of such traumatic lesions in children [1,2,3,6,7,8,9,10].…”

Section: Introductionmentioning

confidence: 99%

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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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Experimental epidural hematoma causes cerebral infarction and activates neocortical glial and neuronal genesis in adult guinea pigs

Pan

Gao

et al. 2012

J of Neuroscience Research

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Epidural hematoma (EDH) is a type of life-threatening traumatic brain injury. Little is known about the extent to which EDH may cause neural damage and regenerative response in the cerebral cortex. Here we attempted to explore these issues by using guinea pigs as an experimental model. Unilateral EDH was induced by injection of 0.1 ml autologous blood into the extradural space, with experimental effects examined at 7, 14, 30, and 60 days postlesion. An infarct developed in the cortex deep to the EDH largely after 7 days postlesion, with neuronal death occurred from layers I to V in the central infarct region, as evidenced by loss of immunoreactivity (IR) for neuron-specific nuclear antigen (NeuN). Glial fibrillary acidic protein (GFAP) IR appeared as a cellular band surrounding the infarct and extending into the periinfarct cortex along the pia. Doublecortin (DCX) IR emerged in these same areas, with labeled cells appearing as astrocytic and neuronal profiles. DCX/GFAP colocalization was found in these regions commonly at 7 and 14 days postlesion, whereas DCX/NeuN-colabeled neurons were detectable at 30 and 60 days postlesion. Subpopulations of GFAP-, DCX-, or NeuN-immunoreactive cells colocalized with the endogenous proliferative marker Ki-67 or bromodeoxyuridine (BrdU) after pulse-chase with this birth-dating marker. The results suggest that experimental EDH can cause severe neuronal loss, induce significant glial activation, and promote a certain degree of local neuronal genesis in adult guinea pig neocortex. These findings point to potential therapeutic targets for improving neuronal recovery in clinical management of EDH.

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

Cited by 36 publications

References 25 publications

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

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

Experimental epidural hematoma causes cerebral infarction and activates neocortical glial and neuronal genesis in adult guinea pigs

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