Korean J Neurotrauma.  2012 Oct;8(2):99-103. 10.13004/kjnt.2012.8.2.99.

Traumatic Epidural Hematoma of the Posterior Cranial Fossa

• Han J
• Cho TG
• Moon JG
• Lee HK
• Kim CH

• KMID: 1427718
• DOI: http://doi.org/10.13004/kjnt.2012.8.2.99

Abstract

OBJECTIVE
Epidural hematoma of posterior fossa is less common than epidural hematoma of supratentorial area, and there are not many articles about epidural hematoma of posterior fossa. This study investigated patients who underwent surgery of epidural hematoma of posterior fossa, and the relation between the clinical manifestation and postoperative outcome.
METHODS
A retrospective analysis performed of 27 patients who underwent operation for acute traumatic epidural hematoma of posterior fossa from January 2004 to December 2011. Analyzed factors were gender, age, Glasgow Coma Scale (GCS) measured upon presentation to the hospital, preoperative GCS score, cause of trauma, time elapsed from the accident to the presentation to the hospital, time elapsed from the presentation to the hospital to the surgery, radiographic findings (brain CT findings), and Glasgow Outcome Scale (GOS).
RESULTS
Two patients (7.4%) had GCS score on admission of 3-8, 11 (29.6%) had 9-12, and 17 (66.7%) had 13-15. In 1 (3.7%) patient, GCS score changed from 13 to 10, and preoperative GCS score was significantly correlated with GOS score (p<0.05). Mean thickness of hematoma was 19.3+/-7.5 mm, and was significantly correlated with GOS score (p<0.05). GOS score was 4-5 in 24 patients (88.9%), 3 (severe disability) in 1 patient (3.7%), and 1 (death) in 2 patients (7.4%).
CONCLUSION
In the patients underwent surgery for epidural hematoma of posterior fossa, 88.9% had favorable outcome (in GOS score of 4 or more). Preoperative GCS score and thickness of hematoma on brain computed tomography are important determinants of prognosis.

Keyword

Posterior cranial fossa; Epidural hematoma; Trauma; Prognostic factor

MeSH Terms

Brain
Cranial Fossa, Posterior
Glasgow Coma Scale
Glasgow Outcome Scale
Hematoma
Humans
Prognosis
Retrospective Studies

Reference

1). Asanin B. Traumatic epidural hematomas in posterior cranial fossa. Acta Clin Croat. 48:27–30. 2009.

2). Balik V., Lehto H., Hoza D., Sulla I., Hernesniemi J. Posterior fossa extradural haematomas. Cent Eur Neurosurg. 71:167–172. 2010.

3). Bor-Seng-Shu E., Aguiar PH., de Almeida Leme RJ., Mandel M., Andrade AF., Marino R Jr. Epidural hematomas of the posterior cranial fossa. Neurosurg Focus 16: ECP1. 2004.

4). Ceylan S., Kuzeyli K., Baykal S., Akturk F. Bilateral posterior fossa epidural hematoma—report of two cases. Neurol Med Chir (Tokyo). 32:690–692. 1992.

5). Cheung PS., Lam JM., Yeung JH., Graham CA., Rainer TH. Outcome of traumatic extradural haematoma in Hong Kong. Injury. 38:76–80. 2007.

6). Costa Clara JM., Claramunt E., Ley L., Lafuente J. Traumatic extradural hematomas of the posterior fossa in children. Childs Nerv Syst. 12:145–148. 1996.

7). Dirim BV., Orük C., Erdoğan N., Gelal F., Uluç E. Traumatic posterior fossa hematomas. Diagn Interv Radiol. 11:14–18. 2005.

8). Gelabert M., Prieto A., Allut AG. Acute bilateral extradural haematoma of the posterior cranial fossa. Br J Neurosurg. 11:573–575. 1997.

9). Gupta PK., Mahapatra AK., Lad SD. Posterior fossa extradural hematoma. Indian J Pediatr. 69:489–494. 2002.

10). Hayashi T., Kameyama M., Imaizumi S., Kamii H., Onuma T. Acute epidural hematoma of the posterior fossa—cases of acute clinical deterioration. Am J Emerg Med. 25:989–995. 2007.

11). Inoue H., Nakagawa Y., Ikemura M., Shinone K., Okada K., Nata M. A subacute epidural haematoma extending over the occipital region and posterior cranial fossa due to a laceration in the transverse sinus. Int J Legal Med. 126:467–471. 2012.

12). Jang JW., Lee JK., Seo BR., Kim SH. Traumatic epidural haematoma of the posterior cranial fossa. Br J Neurosurg. 25:55–61. 2011.

13). Karasu A., Sabanci PA., Izgi N., Imer M., Sencer A., Cansever T, et al. Traumatic epidural hematomas of the posterior cranial fossa. Surg Neurol. 69:247–251. dicussion 251-252. 2008.

14). Kothari RU., Brott T., Broderick JP., Barsan WG., Sauerbeck LR., Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 27:1304–1305. 1996.

15). Lee BH., Park JT., Kim JM. Treatment results for traumatic epidural hematomas on posterior cranial fossa. J Korean Neurosurg Soc. 35:199–203. 2004.

16). Li TC., Chen Y., Lin SM., Tseng SH. Acute posterior fossa isodense epidural hematoma: diagnostic pitfalls on computed tomography. J Trauma. 63:417–419. 2007.

17). Malik NK., Makhdoomi R., Indira B., Shankar S., Sastry K. Posterior fossa extradural hematoma: our experience and review of the literature. Surg Neurol. 68:155–158. discussion 158. 2007.

18). Otsuka S., Nakatsu S., Matsumoto S., Sato S., Motozaki T., Ban S, et al. Study on cases with posterior fossa epidural hematoma—clinical features and indications for operation. Neurol Med Chir (Tokyo). 30:24–28. 1990.

19). Park H., Lee CH., Kang DH., Hwang SH., Park IS., Jung JM. Posterior fossa extradural hematoma in children. J Korean Neurotraumatol Soc. 1:94–97. 2005.

20). Roka YB., Kumar P., Bista P., Sharma GR., Adhikari P. Traumatic posterior fossa extradural haematoma. JNMA J Nepal Med Assoc. 47:174–178. 2008.

21). 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. 9:139–43. 2012.

22). Son SG., Kim JS., Kim KH., Lee WG., Lee IC., Bae SD. Surgical treatment for posterior fossa epidural hematomas. J Korean Neurosurg Soc. 33:562–566. 2003.

23). Wong CW. The CT criteria for conservative treatment—but under close clinical observation—of posterior fossa epidural haematomas. Acta Neurochir (Wien). 126:124–127. 1994.