Retroclival hematoma in the pediatric population

Abstract

Case reports of retroclival hematoma are infrequent, and little is known about the mechanism of formation of the lesion, its management strategy, and the outcome in affected patients. The authors report two cases of posttraumatic retroclival hematoma in children and discuss the available literature. Both patients were treated with cervical immobilization and had good outcomes. Retroclival hematomas are rare. Most reported cases involve pediatric patients in whom the hematomas developed in association with trauma. Spinal trauma in children mainly occurs at the craniovertebral junction due to a high fulcrum of cervical motion and results in ligamentous injuries more often than fractures. The formation of epidural hematomas posterior to the clivus is likely to be due to either clivus fracture or ligament disruption. A high index of suspicion is essential in making the diagnosis. Magnetic resonance imaging is superior to computed tomography in demonstrating retroclival hematomas because of its superiority in delineating the extradural spaces and the integrity of the ligaments. The authors conclude that in most cases retroclival hematomas can be treated conservatively and good outcomes can be expected.