Vertebral angiography in diagnosis of traumatic hematomas of the posterior fossa (author's transl)

Abstract

Nine cases of traumatic hematoma of the posterior fossa are reported and the diagnostic value of the vertebral angiography is emphasized. 1. The diagnosis of an acute posterior fossa hematoma by physical examination is known to be difficult. It is our practice to perform emergency vertebral angiography, when the patients with occipital bone fracture develop disturbances of consciousness and changes of vital signs. We prefer preoperative vertebral angiography to exploratory trephination without angiography. 2. In five of our nine cases there were combined supra and infratentorial hematomata, all of which were found by preoperative angiographies. On the other hand there were two cases of frontal intracerebral hematoma diagnosed by angiography, whose clinical diagnosis had been posterior fossa hematoma. Retrograde right brachial angiography is an excellent mean to see both supra-and infratentorial lesions simultaneously. 3. One can differentiate a posterior fossa epidural hematoma from a subdural hematoma by angiography since an avascular area. of the subdural hematoma does not extend the cerebellar tentorium. 4. In one case extravasation of contrast medium from the posterior inferior cerebellar artery during angiography clearly demonstrated the bleeding point. In some other cases the deformity of the lateral sinus suggested the site of lateral sinus injury. In another case extravasation of contrast medium from the lateral sinus was suspected. Some surgeons feel that one should perform immediate exploratory trephination without vertebral angiography, when posterior fossa hematoma is suspected. However, we are of opinion that an emergency vertebral angiography can be performed without wasting time, while the emergency operation is being prepared. Vertebral angiography can provide invaluable informations for planning the operation about the site, size and multiplicity of the hematoma. In conclusion, it is important to have the neurosurgical service system in which emergency vertebral angiography can be performed without delay in any circumstances.