Resolution of Posterior Fossa Extradural Haematoma by Conservative Treatment: A Case Report

Sharma Krishan Kumar,Ali Asgar

doi:10.23937/2643-4474/1710074

Abstract

Surgical intervention in posterior fossa extradural haematoma (PFEDH) carries very good results. But there are no defined indications for surgical evacuation when patient is asymptomatic and normal neurologically, even in the guidelines for surgical management of traumatic brain injury by 'the brain trauma foundation & the congress of neurological surgeons'. Haematoma volume > 10 ml, haematoma thickness > 15 mm, perimesencephalic cisterns obliteration, fourth ventricle displacement and hydrocephalus, arethe criteria considered for surgical evacuation by most of neurosurgeons.

Highlights

Posterior fossa extradural haematoma (PFEDH) often requires urgent surgical removal because of availability of limited space as compared to supratentorial compartment
Left PFEDH haematoma showed marked resolution in CT scan head done after three weeks (Figure 2) and resolved completely in CT scan head done after six weeks (Figure 3)
PFEDH resolved completely in six weeks’ time, saving patient from unnecessary surgical intervention and risks from anaesthesia & surgery. This suggests that in patient of asymptomatic PFEDH with significant volume, conservative treatment is a potential approach as shown by other studies

Summary

Introduction

Posterior fossa extradural haematoma (PFEDH) often requires urgent surgical removal because of availability of limited space as compared to supratentorial compartment. According to the guidelines for surgical management of traumatic brain injury by ‘the brain trauma foundation & the congress of neurological surgeons [1], extra dural haematoma with volume greater than 30 ml should undergo surgical evacuation, regardless of Glasgow coma scale [2]. There are no definite guidelines when to operate and when not to operate a PFEDH in neurologically normal patients. Patient presented here was left PFEDH (volume 20 cc) and should have undergone immediate surgical removal. The patient was treated conservatively and showed complete resolution in six weeks time. CT scan head (Figure 1) showed left posterior fossa extradural haematoma (50 × 20 × 40 mm, volume 20 cc). Left PFEDH haematoma showed marked resolution in CT scan head done after three weeks (Figure 2) and resolved completely in CT scan head done after six weeks (Figure 3)

Discussion

Conclusion