Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients

Abstract

PurposePosterior fossa epidural hematomas (PFEDH) are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination mini-craniectomy.MethodsWe retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015.ResultsDuring this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications.ConclusionOur results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.

Rapid resolution of a traumatic venous epidural hematoma in a 3-year-old child: illustrative case

“…Increased cerebellar pressure and brainstem compression have been described as life-threatening complications that require surgical evacuation. 2,3 In neurologically stable patients, observational treatment remains a valid option. 4 In younger infants, specific clinical parameters for conservative treatment have been proposed.…”

Hematoma epidural da fossa posterior na infância. Relato de caso e revisão da literatura

“…Sencer et al 3 recomendam o acompanhamento clinico em casos de espessura do hematoma <5 mm. Sheng et al 23 indicam cirurgia quando o volume do hematoma for > 10 ml ou na presença de compressão/deslocamento do quarto ventrículo e/ou ventriculomegalia obstrutiva. Sheng et al 23 têm obtido bons resultados ao utilizarem minicraniectomia após trefinação em pacientes selecionados, os quais apresentavam volume moderado do hematoma e funções neurológicas estáveis.…”

“…Sheng et al 23 indicam cirurgia quando o volume do hematoma for > 10 ml ou na presença de compressão/deslocamento do quarto ventrículo e/ou ventriculomegalia obstrutiva. Sheng et al 23 têm obtido bons resultados ao utilizarem minicraniectomia após trefinação em pacientes selecionados, os quais apresentavam volume moderado do hematoma e funções neurológicas estáveis. Segundo Mohanty et al 24 , em caso de HEFP, está indicada intervenção cirúrgica, inclusive nos casos de pequeno volume, pois devido ao fato da fossa posterior ser pequena, pode ocasionar efeito de massa em um Hidrocefalia pode ocorrer quando existe um determinado efeito de massa na fossa posterior, sendo associada com péssimo prognóstico 3,5 .…”