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Cooper RJ, Akie TE, Gujral T, Rana S, Bui K, Factora R, Quinones A, Gupta M, Hendey GW, Rodriguez RM, Mower WR. Traumatic injury to the posterior fossa: a secondary analysis and description of case series from the NEXUS head injury dataset. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100760. [PMID: 38764982 PMCID: PMC11101874 DOI: 10.1016/j.lana.2024.100760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/21/2024]
Abstract
Background Traumatic brain injuries involving the posterior fossa are rare and case reports indicate they often result in severe outcomes. We seek to describe characteristics and outcomes of traumatic posterior fossa injuries. Methods We performed a planned secondary analysis of all patients with posterior fossa injuries enrolled in the NEXUS head computed tomography (CT) validation study dataset. The dataset includes prospectively collected data on all patients undergoing non-contrast cranial CT following blunt traumatic head injury from April 2006 to December 2015, at four emergency departments comprising community and university sites, as well as urban, suburban and rural settings in California (Antelope Valley Hospital, San Francisco General Hospital, UCLA Ronald Reagan Medical Center, UCSF Fresno Community Regional Medical Center). We classified each patient into one of three injury patterns: Type I-notable traumatic injuries primarily above the tentorium, with minimal posterior fossa involvement; Type II-notable traumatic injuries both above and within the posterior fossa; and Type III-notable traumatic injuries primarily within the posterior fossa. We extracted demographic data for each patient as well as physician assessments of the NEXUS head CT and Canadian Head CT rule clinical criteria, mechanisms of injury, patient outcomes, and the location and types of intracranial injuries sustained. Findings Of 11,770 patients in the database, 184 (1.6%) had posterior fossa injuries on CT imaging. Mean age was 55.4 years (standard deviation 22.5 years, range 2-96 years); 131 (71.2%) were males. We identified 63 patients with Type I injuries, 87 with Type II injuries, and 34 Type III injuries. The most common mechanisms of injury were falls (41%), pedestrian vs automobile (15%), and motor vehicle collisions (13%). On presentation most patients had altered mental status (72%), abnormal behavior (53%), or a neurologic deficit (55%). The majority of individuals, 151 (82%), had clinically important injuries and 111 (60%) required neurosurgical intervention. The dispositions for the subjects included 52 deaths (28%), 49 (27%) patients discharged home, and 48 (26%) discharged to rehabilitation facilities. When compared to individuals with Type I and Type II injuries, patients with Type III injuries had lower mortality (6% vs 30% and 35%) and higher percentage of patients discharged home (60% vs 19% and 21%). Interpretation Patients with Type I and II injury patterns (those that involve both the posterior fossa and supratentorium) experienced high mortality and disability. Patients with Type III injuries (isolated posterior fossa) had a better prognosis. Funding None.
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Affiliation(s)
- Richelle J. Cooper
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas E. Akie
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Tarika Gujral
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shivam Rana
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kyle Bui
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ryan Factora
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alexandra Quinones
- Department of Emergency Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Malkeet Gupta
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- Antelope Valley Hospital, Lancaster, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gregory W. Hendey
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- UCSF-Fresno, Medical Education Program, Fresno, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert M. Rodriguez
- Department of Emergency Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - William R. Mower
- Department of Emergency Medicine, Ronald Reagan – University of California, Los Angeles Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Foster MA, Collins MR, Wertin TM, Azurdia AR, Lettieri SC, Feiz-Erfan I. Management of epidural hematomas of the posterior Cranial Fossa. World Neurosurg X 2024; 21:100263. [PMID: 38187504 PMCID: PMC10770538 DOI: 10.1016/j.wnsx.2023.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/29/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Michael A. Foster
- Division of Neurosurgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- University of Arizona, College of Science, Tucson, AZ, USA
| | - Michael R. Collins
- Department of Radiology, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Thomas M. Wertin
- Division of Trauma, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Adrienne R. Azurdia
- Department of Emergency Medicine, Valleywise Health Medical Center, Phoenix, AZ, USA
- Department of Emergency Medicine, Honor Health Osborn, Scottsdale, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Salvatore C. Lettieri
- Division of Plastic Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Division of Plastic Surgery, Mayo Clinic, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Iman Feiz-Erfan
- Division of Neurosurgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
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Jamous MA, Samara QA, Jbarah OF, Ahmed YB. Management of traumatic posterior fossa epidural hematomas in pediatrics: our experience and review of the literature. Childs Nerv Syst 2021; 37:2839-2846. [PMID: 34129079 DOI: 10.1007/s00381-021-05248-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Conservative management of posterior fossa epidural hematoma in the pediatric age group has been increasingly considered in the last decade with good clinical outcomes and comparable results to surgical intervention in carefully selected patients. The purpose of this study is to evaluate the outcome of observation in the management of pediatric patients with posterior fossa epidural hematoma (PFEDH) in our tertiary hospital and present a literature review on PFEDH pediatric patients. METHODS We conducted a retrospective observational study at King Abdullah University Hospital (KAUH), a tertiary hospital in North Jordan. All pediatric patients (≤ 18 years) who were admitted with a diagnosis of PFEDH from January 2010 to December 2020 were included. Demographic data, trauma type, clinical signs and symptoms on admission, CT findings, treatment type, and outcomes were collected and assessed. The outcome was measured using the Glasgow outcome scale (GOS) on discharge from the hospital. RESULTS A total of 16 patients were identified and included in this study. Nine patients were managed conservatively and 7 surgically. The mean age was 7.7 ± 6 years ranging from 1 to 18 years. Falls were the most common cause of injury. Vomiting was the most frequent presenting symptom. Except for 1 patient, 14 patients had good outcomes with a GOS of 5. One case of mortality was seen in our series. CONCLUSION Posterior fossa epidural hematoma is a rare clinical condition among the pediatric age group. Early and consecutive CT scans must be obtained for all suspected cases. Successful conservative management can be achieved depending on multiple factors such as hematoma thickness or volume, neurological status on admission, and other radiological findings as shown in our study. The overall prognosis was good in our patients.
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Affiliation(s)
- Mohammad A Jamous
- Department of Neuroscience, Division of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan.
| | - Qais A Samara
- Department of Neuroscience, Division of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan
| | - Omar F Jbarah
- Department of Neuroscience, Division of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan
| | - Yaman B Ahmed
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Ehrhardt JD, Elkbuli A, McKenney M, Renda M. Multidisciplinary management of a traumatic posterior meningeal artery pseudoaneurysm: A case report and review of the literature. Int J Surg Case Rep 2021; 82:105933. [PMID: 33957406 PMCID: PMC8113848 DOI: 10.1016/j.ijscr.2021.105933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background Meningeal arterial injuries represent <1% of all blunt traumatic brain injuries (TBIs). Middle meningeal artery (MMA) lesions comprise the majority. However, there is little clinical data on posterior meningeal artery (PMA) injuries. Case report A 69-year-old man was brought to our trauma center after sustaining a fall inside a warehouse. He was GCS (Glasgow Coma Scale) 3 on arrival. Non-contrast CT (computed tomography) brain showed subarachnoid hemorrhage with diffuse cerebral edema and a basilar skull fracture. The patient subsequently underwent emergency ventriculostomy. Immediately after the procedure, further imaging with CTA (computed tomography angiography) head identified a hyperintense posterior cranial fossa lesion, prompting cerebral angiography with identification and embolization of a traumatic PMA pseudoaneurysm. The patient improved and was discharged to a long-term acute care facility. At 3 months post-discharge, the patient was eating, talking with family, and working aggressively with physical therapy. Discussion This case represents a functional neurologic outcome from a rare subset of TBI. Early CTA head imaging is not supported by limited literature, but allowed for expedient identification and definitive management of this PMA pseudoaneurysm. In the critical care setting, hyperosmolar therapy, CSF (cerebrospinal fluid) drainage, prompt enteral nutritional support, and early tracheostomy all represent evolving evidence-based strategies to optimize care for severe TBI. Conclusions The initial evaluation and management of severe TBI can be nuanced. Future research may refine indications for CTA head to the diagnostic evaluation of patients with both severe TBI and skull fractures. Traumatic intracerebral hemorrhage caused by meningeal artery injuries are rare, and usually involve the middle meningeal artery; lesions of the posterior meningeal artery remain even more obscure Severe traumatic brain injury (TBI) associated with basilar skull fractures represents a pattern of injury for which CT angiography of the head can be useful in identifying meningeal vascular injuries Critical care for severe TBI involves preventing secondary insult to cerebral tissue; strategies continue to evolve with hyperosmolar therapy, CSF drainage, prompt enteral nutritional support, and early tracheostomy
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Affiliation(s)
- John D Ehrhardt
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA
| | - Michael Renda
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA
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Chaoguo Y, Xiu L, Liuxun H, Hansong S, Nu Z. Traumatic Posterior Fossa Epidural Hematomas in Children : Experience with 48 Cases and a Review of the Literature. J Korean Neurosurg Soc 2019; 62:225-231. [PMID: 30840978 PMCID: PMC6411576 DOI: 10.3340/jkns.2016.0506.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Epidural haematoma (EDH) most commonly occurs in the supratentorial area, particularly in the temporal region, of the brain. Posterior fossa epidural haematoma (PFEDH) is less frequently observed, accounting for only 1.2% to 12.9% of all EDH cases. Because of the non-specific symptoms and the potential for rapid and fatal deterioration in children, an early computed tomography (CT) scanning is necessary for all suspicious cases. The aim of the present study was to share the experience of 48 cases and review the literature concerning PFEDH. METHODS A retrospective analysis was conducted for 48 paediatric cases diagnosed with PFEDH and admitted to Yuying Children's Hospital of Wenzhou Medical University from January 2010 to August 2015. The clinical features and outcomes were analyzed and compared with previous literature. RESULTS Seventeen patients were surgically treated in this series and 31 patients received non-operative treatment. The outcomes were good in 46 patients, evaluated using the Glasgow outcome score (GOS), while mild disability was observed in one patient, and only one case showed severe disability. There were no cases of mortality in this series. CONCLUSION Posterior fossa epidural haematoma is relatively rare compared with supratentorial epidural haematoma. Early and serial CT scans should be performed for all suspicious cases. The criteria for the surgical treatment of paediatric patients with PFEDH were concluded. The overall prognosis was excellent in paediatric patients.
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Affiliation(s)
- You Chaoguo
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou , China
| | - Long Xiu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou , China
| | - Hu Liuxun
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou , China
| | - Sheng Hansong
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou , China
| | - Zhang Nu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou , China
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Xu Q, Chen J, Liu J, Sun C, Lu J, Wang D. Unusual, Acute, and Delayed Traumatic Torcular Herophili Epidural Hematoma Causing Malignant Encephalocele During Surgery: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1030-1034. [PMID: 30154398 PMCID: PMC6124356 DOI: 10.12659/ajcr.910030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 40 Final Diagnosis: Traumatic torcular herophili unusual acute and delayed epidural hematoma Symptoms: Coma Medication: — Clinical Procedure: Craniotomy Specialty: Neurosurgery
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Affiliation(s)
- Qinyi Xu
- Department of Neurosurgery, Huishan People's Hospital of Wuxi, Wuxi, Jiangsu, China (mainland)
| | - Junhui Chen
- Department of Neurosurgery, 101st Hospital of People's Liberation Army (PLA), Wuxi, Jiangsu, China (mainland)
| | - Jun Liu
- Department of Neurosurgery, Huishan People's Hospital of Wuxi, Wuxi, Jiangsu, China (mainland)
| | - Chenggguo Sun
- Department of Neurosurgery, Huishan People's Hospital of Wuxi, Wuxi, Jiangsu, China (mainland)
| | - Junjie Lu
- Department of Neurosurgery, Huishan People's Hospital of Wuxi, Wuxi, Jiangsu, China (mainland)
| | - Dong Wang
- Department of Neurosurgery, Huishan People's Hospital of Wuxi, Wuxi, Jiangsu, China (mainland)
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Sheng HS, You CG, Yang L, Zhang N, Lin J, Lin FC, Wang MD. Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients. Chin J Traumatol 2017; 20:212-215. [PMID: 28688799 PMCID: PMC5555239 DOI: 10.1016/j.cjtee.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Posterior 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. METHODS We 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. RESULTS During 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. CONCLUSION Our 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.
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Affiliation(s)
- Han-Song Sheng
- Department of Neurosurgery, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China; Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chao-Guo You
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Yang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nu Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jian Lin
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fen-Chun Lin
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mao-De Wang
- Department of Neurosurgery, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China.
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Abstract
Skull base fractures extend through the floor of the anterior, middle, or posterior cranial fossa. They are frequently associated with complex facial fractures and serious complications such as cranial nerve or vascular injury, cerebrospinal fluid leak, or meningitis. Several distinct patterns of skull base fractures have been recognized, each of them associated with different complications. Recognition of, often subtle, skull base fracture is essential to prevent or allow early treatment of these serious complications.
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Affiliation(s)
- Matthew Bobinski
- Department of Radiology, University of California-Davis School of Medicine, Sacramento, California, United States
| | - Peter Y Shen
- Department of Radiology, University of California-Davis School of Medicine, Sacramento, California, United States
| | - Arthur B Dublin
- Department of Radiology, University of California-Davis School of Medicine, Sacramento, California, United States
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Sencer A, Aras Y, Akcakaya MO, Goker B, Kiris T, Canbolat AT. Posterior fossa epidural hematomas in children: clinical experience with 40 cases. J Neurosurg Pediatr 2012; 9:139-43. [PMID: 22295917 DOI: 10.3171/2011.11.peds11177] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Altay Sencer
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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10
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Jang JW, Lee JK, Seo BR, Kim SH. Traumatic epidural haematoma of the posterior cranial fossa. Br J Neurosurg 2010; 25:55-61. [DOI: 10.3109/02688697.2010.520759] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Singh SK, Ojha BK, Rastogi M, Chandra A, Husain M. Trephine craniotomy for evacuation of posterior fossa extradural hematoma. INDIAN JOURNAL OF NEUROTRAUMA 2008. [DOI: 10.1016/s0973-0508(08)80005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractExtradural hematomas (EDH) commonly occur in the supratentorial region where these are evacuated by trephine or craniotomy. Posterior fossa EDH (PFEDH) account for 4% to 12.9% of all cranial EDH and the standard method for evacuation of PFEDH involves a suboccipital craniectomy. Use of a trephine craniotomy for evacuation of PFEDH has not yet been described. This is the first report describing our experience in 8 patients with PFEDH where a sub occipital trephine craniotomy was used for evacuation of PFEDH. Eight patients with PFEDH were operated at our institution using a trephine for making a sub occipital craniotomy. Park bench position was used in all patients. The procedure was safely and expeditiously completed with no significant peri-operative complications related to the procedure. Operative time was comparatively shorter than for traditionally described procedures. Replacing the bone flap also avoids any scope for the possibility of occurrence of the sinking skin flap syndrome. We think that using a trephine for making a sub occipital craniotomy for evacuation of PFEDH is a feasible and safe option. There is no added risk of venous sinus injury. Replacing the bone flap helps to restore the normal anatomy. Use of central and peripheral dural hitch sutures in patients of traumatic PFEDH is feasible and avoids any possible reaccumulation of hematoma.
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Karasu A, Sabanci PA, Izgi N, Imer M, Sencer A, Cansever T, Canbolat A. Traumatic epidural hematomas of the posterior cranial fossa. ACTA ACUST UNITED AC 2008; 69:247-51; dicussion 251-2. [DOI: 10.1016/j.surneu.2007.02.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 02/08/2007] [Indexed: 12/20/2022]
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Abstract
OBJECT The purpose of this paper was to clarify the clinical features of temporal tip epidural hematomas (EDHs). METHODS A retrospective chart review was conducted for 53 patients who had suffered an EDH. They were divided into two groups, those whose hematoma occurred in the temporal tip (23 patients) and others (30 patients). The following variables were analyzed: age, sex, Glasgow Coma Scale score, systolic blood pressure on admission, Injury Severity Score, incidence of hematomas in intracerebral regions, location of skull fracture, incidence of cranial nerve injury, type of operation, and Glasgow Outcome Scale (GOS) score at 3 months postinjury. RESULTS A greater incidence of zygomatic arch or lateral orbital cavity fracture was found in the "temporal tip" group than in the "other" group. There was a greater incidence of cranial nerve injury in the temporal tip (26.0%) than in the other group (6.6%; p < 0.05). Surgery to treat the EDH was more frequently performed in the other group (36.6%) than in the temporal tip group (two patients, 8.6%; p = 0.01). There were no significant differences between the groups in terms of the GOS score. CONCLUSIONS A temporal tip hematoma is not a rare injury among patients with EDHs. This hematoma tends to be induced by lateral orbital cavity and/or zygomatic arch fractures. It tends to be associated with cranial nerve injury, but it rarely requires an operation. The outcome of patients with this hematoma depends on the associated intracerebral lesions, thus indicating it to be similar to an EDH in other places.
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Affiliation(s)
- Youichi Yanagawa
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
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Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger J. Surgical Management of Posterior Fossa Mass Lesions. Neurosurgery 2006; 58:S47-55; discussion Si-iv. [PMID: 16540745 DOI: 10.1227/01.neu.0000210366.36914.38] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
RECOMMENDATIONS (see Methodology)
Indications
Timing
Methods
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Affiliation(s)
- M Ross Bullock
- Department of Neurological Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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Bor-Seng-Shu E, Aguiar PH, de Almeida Leme RJ, Mandel M, Andrade AFD, Marino R. Epidural hematomas of the posterior cranial fossa. Neurosurg Focus 2004; 16:ECP1. [PMID: 15209492 DOI: 10.3171/foc.2004.16.2.10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors present their experience in the management of posterior fossa epidural hematoma (PFEDH), which involved an aggressive diagnostic approach with the extensive use of head computerized tomography (CT) scanning.
Methods
The authors treated 43 cases of PFEDH in one of the largest health centers in Brazil. Diagnosis was established in all patients with the aid of CT scanning because the clinical manifestations were frequently nonspecific. Cases were stratified by clinical course, Glasgow Coma Scale score, and their radiological status. Based on clinical and radiological parameters the patients underwent surgical or conservative management.
Conclusions
Compared with outcomes reported in the available literature, good outcome was found in this series. This is primarily due to the broad use of CT scanning for diagnostic and observational purposes, which, in the authors' opinion, led to early diagnosis and prompt treatment.
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MESH Headings
- Accidental Falls
- Accidents, Traffic
- Adolescent
- Adult
- Brain Injuries/complications
- Brazil/epidemiology
- Child
- Child, Preschool
- Cranial Fossa, Posterior/injuries
- Female
- Glasgow Coma Scale
- Hematoma, Epidural, Cranial/diagnosis
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/surgery
- Humans
- Hydrocephalus/etiology
- Hydrocephalus/surgery
- Male
- Middle Aged
- Retrospective Studies
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Edson Bor-Seng-Shu
- Division of Neurosurgery, Hospital das Clinicas, Sao Paulo University Medical School, Sao Paulo, Brazil
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Shukla V, Hayman LA, Taber KH. Adult cranial dura II: venous sinuses and their extrameningeal contributions. J Comput Assist Tomogr 2003; 27:98-102. [PMID: 12544251 DOI: 10.1097/00004728-200301000-00018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This is the second of two articles designed to provide detailed user-friendly schematics of the adult dural vascular anatomy. It supplements the first article on the intrinsic meningeal arteries and veins by describing the dural venous sinuses along with their three remaining connections: to the brain, to the diploë, and to the extracranial soft tissues. The discussion of this anatomy is supplemented by illustrative pathologic insights. This information will assist in interpreting neuroimaging studies, communication with clinicians, and teaching of this complex subject.
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Affiliation(s)
- Vershalee Shukla
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Abstract
This is the first of two articles designed to provide user-friendly schematics of the adult dural vascular anatomy. It describes the intrinsic meningeal arteries and veins of the skull base/cranial vault and the dural partitions (the tentorium, falx cerebelli, and falx cerebri). The discussion of this anatomy is supplemented by illustrative pathologic insights. The second article focuses on the dural sinuses and their remaining tributaries from the brain, diploë, and emissary veins from the extracranial soft tissues. This information will assist in interpreting neuroimaging studies, communications with clinicians, and teaching of this difficult subject.
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Affiliation(s)
- Vershalee Shukla
- College of Medicine, University of Sasketchewan, Saskatoon, Saskatchewan, Canada
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Koç RK, Paşaoğlu A, Menkü A, Oktem S, Meral M. Extradural hematoma of the posterior cranial fossa. Neurosurg Rev 1998; 21:52-7. [PMID: 9584287 DOI: 10.1007/bf01111486] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fourteen cases of an extradural hematoma of the posterior fossa (EDHPF), are presented and the clinical and radiological finds are described. The onset of symptoms was acute in 10 patients and subacute in the other 4. Hematomas occurred in the younger age groups with a clear male predominance. Nine cases had suffered a blow to the head. A fracture of the occipital bone was seen in 86% of the patients. The bleeder could be identified in 10 cases, and in 6 of these the source was a bleeding transverse sinus. The overall mortality was 14.2%, but only patients with an acute course died (20%). All subacute cases survived. This study revealed that the most important factors influencing mortality were late diagnosis and late treatment. Coexisting intracranial lesions had no influence on mortality. According to the literature, there has been a certain decrease in mortality in the acute and subacute course patients since the introduction of computed tomography (CT) scanning. Emphasis is placed on the importance of occipital soft-tissue swelling and occipital fracture as clues to the possible presence of extradural hematomas, and of using the CT in all such patients even if no clinical symptoms are present.
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Affiliation(s)
- R K Koç
- Department of Neurosurgery, Erciyes University, School of Medicine, Kayseri, Turkey
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