Traumatic Posterior Fossa Hematoma, A Rare Entity: Study of 21 Cases

Abstract

Background Traumatic posterior fossa hematoma is a rare entity. Traumatic posterior fossa hematomas are associated with considerable morbidity and mortality and their surgical management remained controversial. Methods From August 2011 to August 2017, approximately 5,100 patients with head injury were managed. Authors reviewed clinical and radiological findings, management criteria, and outcome of posterior fossa hematoma in 21 patients. Results Out of 21 cases, 13 survived with our management. The Glasgow Coma Scale (GCS) on admission was higher in favorable group than in poor outcome group. Factors associated with Glasgow Outcome Scale in two groups were status of fourth ventricle, basal cisterns, subarachnoid hemorrhage (SAH), hematoma volume, and their location (hemispheric or midline). Similarly, associated supratentorial lesions, age, gender, lesions in other parts of body, and timing from injury to reporting to hospital were taken into consideration. Conclusion The factors correlated with patient outcome were age, sex, mode of injury, GCS at admission, associated intracranial hematomas, associated SAH, hematoma volume, hematoma location, basal cisterns, status of fourth ventricle, and associated multiple injuries on other body parts. It is hereby concluded that timely surgical intervention should be employed whenever indicated without delay. Posterior fossa hematomas were rarely observed in the pediatric age group.

Traumatic isolated intracerebellar haematoma without any supratentorial lesion

“…In accordance with previous studies on this topic our data showed GCS at initial presentation to be the most predictive clinical tool 5,6,7,21,23,25 . Domenico d'Avella et al 7 suggest that A GCS score of less than 8 was the most powerful adverse prognostic factor (58.78% probability of poor outcome as sole covariate) .…”

“…In this study fall from bike and pillan rider are the most common mechanism of injury. Bhardwaj et al has 15/21( 71.14%) 5 , Harsh et al has 15/23 ( 65.21%) 23 .…”

“…So Early surgery is good always . it indicated that timing of surgery is one of the most prognostic factor for outcome 5,7 .…”

“…Total medial hematoma is 15 patients in which 7 patients had poor outcome (7/15-46.66%) and superficial hematoma in 45 patients in which only 4 patients has poor outcome (4/45-8.88%). It indicates that medial/deep hematoma has poor outcome 5,15,23 . In group A subgroup 1 st 7 patients has hematoma size > 3 cm and 5 worsened ( 5/7-71.42%) and then operated .. Subgroup 2 nd has size < 3 cm only 3 patient worsened (3/23-13.04%) , which is also due to midline position.…”

“…In group A subgroup 1 st 7 patients has hematoma size > 3 cm and 5 worsened ( 5/7-71.42%) and then operated .. Subgroup 2 nd has size < 3 cm only 3 patient worsened (3/23-13.04%) , which is also due to midline position. So it is proven that size is important prognostic factor 4,5,7 . Hematoma of > 3 cm size should operate early whether GCS > 13.So size is important factor to take decision of surgery.…”