Surgical Treatment for Posterior Fossa Epidural Hematomas

Son, Seong Geun; Kim, Joon Soo; Kim, Kyu Hong; Lee, Woon Gi; Lee, In Chang; Bae, Sang Do

Abstract

OBJECTIVE
The purpose of this study is to investigate the interactions between prognostic factors and functional outcome of patients surgically treated posterior fossa epidural hematomas. METHODS: Between 1992 and 2001, twenty patients were surgically treated for the posterior fossa epidural hematomas. The medical records and radiologic findings of the patients were reviewed retrospectively. Information on potential prognostic factors was collected, and then univariate analysis was performed to determine significant prognostic factors. RESULTS: Initial Glasgow Coma Scale scores of 12 patients were 13 or better. Occipital skull fractures were found in 16 cases(80%). The degree of 4th ventricle compression measured on computed tomography scan. Seven cases showed total obliteration, nine cases showed partial obliteration and four cases showed normal. Eighteen patients experienced good or moderate outcomes(Glasgow Outcome Scale scores of 4 or 5). Functional outcome showed a significant correlation with Glasgow Coma Scale score, degree of 4th ventricle compression(p<.05). CONCLUSION: If poor initial consciousness level and severe 4th ventricle compression are noted, early and aggressive treatment are required. Although clinical progression of posterior fossa epidural hematoma is silent and slow, the deterioration might be sudden and quick to become fatal if not promptly treated.