Trephine craniotomy for evacuation of posterior fossa extradural hematoma

Abstract

Extradural hematomas (EDH) commonly occur in the supratentorial region where these are evacuated by trephine or craniotomy. Posterior fossa EDH (PFEDH) account for 4% to 12.9% of all cranial EDH and the standard method for evacuation of PFEDH involves a suboccipital craniectomy. Use of a trephine craniotomy for evacuation of PFEDH has not yet been described. This is the first report describing our experience in 8 patients with PFEDH where a sub occipital trephine craniotomy was used for evacuation of PFEDH. Eight patients with PFEDH were operated at our institution using a trephine for making a sub occipital craniotomy. Park bench position was used in all patients. The procedure was safely and expeditiously completed with no significant peri-operative complications related to the procedure. Operative time was comparatively shorter than for traditionally described procedures. Replacing the bone flap also avoids any scope for the possibility of occurrence of the sinking skin flap syndrome. We think that using a trephine for making a sub occipital craniotomy for evacuation of PFEDH is a feasible and safe option. There is no added risk of venous sinus injury. Replacing the bone flap helps to restore the normal anatomy. Use of central and peripheral dural hitch sutures in patients of traumatic PFEDH is feasible and avoids any possible reaccumulation of hematoma.