J Korean Neurosurg Soc.  2019 Mar;62(2):225-231. 10.3340/jkns.2016.0506.007.

Traumatic Posterior Fossa Epidural Hematomas in Children : Experience with 48 Cases and a Review of the Literature

• Chaoguo Y
• Xiu L
• Liuxun H
• Hansong S
• Nu Z

• KMID: 2441567
• DOI: http://doi.org/10.3340/jkns.2016.0506.007

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.

Keyword

Cranial fossa; Posterior; Hematoma; Epidural; Traumatic; Child

MeSH Terms

Brain
Child*
Hematoma*
Humans
Mortality
Prognosis
Retrospective Studies
Temporal Lobe
Tomography, X-Ray Computed

Figure

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  Fig. 1. Case of a 10-year-old girl with surgically managed PFEDH. A : Preoperative cT scans showing a large, left-sided, mixture density haematoma with a significant mass effect. b : bony windows showing that an occipital bone fracture was not detected. c : A postoperative image showing the near complete evacuation of the haematoma. PFEDH : posterior fossa epidural haematoma, cT : computed tomography.

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  Fig. 2. Case of a 5-year-old boy with conservatively managed PFEDH. A : Plain cT at admission revealing two PFEDH on the left side without mass effects. b : Follow-up cT after 48 hours showing a slight reduction of the haematoma. c : Repeat scan after 6 days showing the almost complete absorption of the haematoma. PFEDH : posterior fossa epidural haematoma, cT : computed tomography.

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  Fig. 3. Case of a 3-year-old child with surgically managed bilateral PFEDH (A) with a linear fracture of the occipital bone (b). PFEDH : posterior fossa epidural haematoma.

Reference

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