Posterior Fossa Epidural Hematoma Research Articles

Case of triple extradural hematoma in a single patient: A rare case report

Epidural hematoma (EDH) is found in 1–4% of traumatic brain injury cases. Acute triple extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5–1% of all extradural hematomas. Here is a case report of a 36-year-old female patient who presented to us with a head injury due to fall from a bike due to collision with a stray animal. The patient had a Glasgow Coma Scale of 9 (E2V2M5) with bilateral sluggishly reacting pupil to light. Computed tomography showed asymmetric bilateral posterior fossa EDHs along with an extradural hematoma in the right frontal region with multiple small contusions with mass effect. The surgical evacuation was performed first of the posterior fossa in the prone position and then right frontal hematoma evacuation in the supine position in the same sitting. The patient recovered well and was discharged on the 10th post-operative day with no neurological deficit. Early drainage of hematomas has been demonstrated to be an effective technique that soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.

Quartet of catastrophe: Bilateral epidural hematoma in both supratentorial and infratentorial compartments – A case report and a novel surgical technique to approach

Background: Epidural hematoma (EDH) is the most common form of traumatic brain lesion in the posterior fossa. This condition is rapidly fatal if not identified and treated accordingly, due to the proximity of the brain stem. Prompt diagnosis is made by early computed tomography (CT) of the head and emergent evacuation is of utmost importance. Case Description: A 28-year-old male presented to the emergency room with complaints of headache and vomiting following a road traffic accident. CT scan revealed EDH around the transverse sinus extending into supratentorial and infratentorial compartment bilaterally. The patient was planned for emergency surgery but relatives did not give consent initially they agreed after 24 h when the patient became unconscious. A midline incision was made and a small infratentorial craniectomy with two burr holes was made bilaterally above the transverse sinus. Excellent recovery was seen following a surgical procedure. Conclusion: Posterior fossa EDH is a rare but potentially fatal entity. Bilateral extension in supratentorial and infratentorial compartments makes it a “quartet of catastrophe.” Prompt diagnosis and emergent evacuation lead to excellent recovery. Two burr holes in supratentorial compartments and a small infratentorial craniectomy can avoid sinus injury.

Axial Convex-Shaped Hematoma was Associated with Poor Curative Effect of Surgical Treatment for Traumatic Posterior Fossa Epidural Hematoma in Children.

Posterior fossa epidural hematoma (PFEDH) is rare which accounts for just 4-12.9% of all EDH cases. Since its frequently subtle and nonspecific clinical presentation, CT scan has great importance for early diagnosis and treatment of PFEDH. However, indications for surgery depending on the findings of CT image are still controversial. We retrospectively analyzed 40 pediatric cases of PFEDH. Their baseline characteristic, clinical presentation, imaging findings and outcomes were collected and analyzed. The ellipsoid volume equation X × Y × Z/2 was used to measure the hematoma volume. The Glasgow Outcome Scale (GOS) was used to assess the neurologic functional outcome. A total of 40 pediatric PFEH patients were included with 8 patients having poor outcome and 32 patients having a relatively good prognosis. GCS score showed a significant difference between good and poor outcome groups (p < 0.001). Y value on CT image was significantly bigger in poor outcome group than good outcome group (p < 0.01). Similar results were got in X/Z value (p < 0.05) and Y/Z value (p < 0.01) which reflected the shape of hematoma. A predictive model with Y + X/Z showed the largest area under the ROC curve with a sensitivity of 75.0% and specificity of 93.7%. GCS score at admission was closely related to the prognosis of the pediatric patients with PFEDH. The morphometry of PFEDH has a crucial role in judging the prognosis. Axial convex-shaped hematoma was associated with poor curative effect of surgical treatment.

Incidences, causes and risk factors of unplanned reoperation within 30days of craniovertebral junction surgery: a single-center experience.

To investigate the incidences, causes, and risk factors for unplanned reoperation within 30days of craniovertebral junction (CVJ) surgery. From January 2002 to December 2018, a retrospective analysis of patients who underwent CVJ surgery at our institution was conducted. The demographics, history of the disease, medical diagnosis, approach and type of operation, surgery duration, blood loss, and complications were recorded. Patients were divided into the no-reoperation group and the unplanned reoperations group. Comparison between two groups in noted parameters was analyzed to identify the prevalence and risk factors of unplanned revision and a binary logistic regression was performed to confirm the risk factors. Of 2149 patients included, 34(1.58%) required unplanned reoperation after the initial surgery. The causes for unplanned reoperation contained wound infection, neurologic deficit, improper screw placement, internal fixation loosens, dysphagia, cerebrospinal fluid leakage, and posterior fossa epidural hematomas. No statistical difference was found in demographics between two groups (P > 0.05). The incidence of reoperation of OCF was significantly higher than that of posterior C1-2 fusion (P = 0.002). In terms of diagnosis, the reoperation rate of CVJ tumor patients was significantly higher than that of malformation patients, degenerative disease patients, trauma patients, and other patients (P = 0.043). The binary logistic regression confirmed that different disease, fusion segment (posterior) and surgery time were independent risk factors. The unplanned reoperation rate of CVJ surgery was 1.58% and the major causes were implant-related failures and wound infection. Patients with posterior occipitocervical fusion or diagnosed with CVJ tumors had an increased risk of unplanned reoperation.

Posterior fossa epidural hematoma: A 6-year management experience.

Through this study, we sought to evaluate the management of posterior fossa extradural hematoma (PFEDH). An observational study was conducted at the Neurosurgery Department of Lady Reading Hospital in Peshawar from January 2015 to December 2020. All patients who had a traumatic acute extradural hematoma (EDH) of the posterior fossa were included, irrespective of age and gender. The clinical predictors and outcomes were assessed, including the CT-scan findings and Glasgow Coma Scale (GCS) score. A total of 104 cases with posterior fossa extradural hematoma were identified from 1252 extradural hematoma patients admitted during the study period. The mean age of the enrolled patients was 18.17 ± 14.31 years. Most of the patients were male (65.39%) and belonged to the pediatric age group, i.e., < 15 years (60.6%). CT scan brain was done in all the cases for diagnosis. In 68.3% of cases, an associated occipital bone fracture was observed. Surgery was done in almost 71.2% of cases, and most of the patients experienced good recovery after surgery, as indicated by the GOS score. Linear regression model revealed that treatment (β=-0.20, p=0.038), time duration between surgery and trauma (β=0.43, p=0.000) and GCS category (β=-0.47, p=0.000) were significantly associated with PFEDH outcomes. In conclusion, PFEDH was frequent among males and the pediatric age group. Serial CT brain is highly recommended in all suspected cases for early diagnosis.

337 Comparison of Outcomes, Signs, and Symptoms of Traumatic Posterior Fossa Epidural Hematoma (PFEDH) Patients Who Managed Surgically Versus Conservatively: A Systematic Review and Meta-Analysis

Abstract Aim To compare patients with PFEDH who managed surgically versus conservatively in terms of signs and symptoms at admission and outcomes at follow-up. Method This systematic review was performed according to PRISMA guidelines on four databases: PubMed, Scopus, EBSCO, and Cochrane central up to December 20th, 2021. Result Eighteen observational studies including 713 patients were assessed quantitatively. The proportion of patients achieved a Glasgow Outcome Scale (GOS) score of 5 was higher in the conservative group (Odds Ratio [OR] = 3.588, p &amp;lt; 0.001) and odds of mortality were lower in the same group (OR = 0.210, P = 0.010). Surgical groups were more likely to have vomiting (OR = 3.316, P = 0.049), loss of consciousness (LOC) (OR = 4.584, P = 0.039), and bone fractures (cranial or facial) (OR = 3.223, P = 0.045), but less likely to have headache (OR = 0.342, P =0.032) at the admission time. There was higher proportion of males in the surgical group (proportion in surgical = 71%, p &amp;lt; 0.001 versus proportion in conservative = 54%, p &amp;lt; 0.001). Conclusion The initial presentation and overall outcomes of PFEDH patients who managed conservatively usually are better than those who managed surgically. This doesn't indicate that conservative management is used all time, as the treatment option should be in accordance with Brain Trauma Foundation's Guidelines in 2006, that surgical intervention is still the mainstay treatment and conservative management is used upon neurosurgeon's discretion depending on admission neurological status and other many criteria.

Modified surgical method of supra- and infratentorial epidural hematoma and the related anatomical study of the squamous part of the occipital bone.

BACKGROUNDSupra- and infratentorial acute epidural hematoma (SIEDH) is a common posterior cranial fossa epidural hematoma located at the inner surface of the squamous part of the occipital bone (SOB). Traditionally, surgical treatment of the SIEDH requires a combined supra-infratentorial craniotomy.AIMTo analyze the morphological characteristics of the SOB and introduce a single supratentorial craniotomy for SIEDH.METHODSSkull computed tomography (CT) scan data from 32 adult patients were collected from January 1, 2019 to January 31, 2020. On the median sagittal plane of the CT scan, the angle of the SOB (ASOB) was defined by two lines: Line A was defined from the lambdoid suture (LambS) to the external occipital protuberance (EOP), while line B was defined from the EOP to the posterior edge of the foramen magnum (poFM). The operative angle for the SIEDH (OAS) from the supra- to infratentorial epidural space was determined by two lines: The first line passes from the midpoint between the EOP and the LambS to the poFM, while the second line passes from the EOP to the poFM. The ASOB and OAS were measured and analyzed.RESULTSBased on the anatomical study, a single supratentorial craniotomy was performed in 8 patients with SIEDH. The procedure and the results of the modified surgical method were demonstrated in detail. For males, the ASOB was 118.4 ± 4.7 and the OAS was 15.1 ± 1.8; for females, the ASOB was 130.4 ± 5.1 and the OAS was 12.8 ± 2.0. There were significant differences between males and females both in ASOB and OAS. The smaller the ASOB was, the larger the OAS was. The bone flaps in 8 patients were designed above the transverse sinus intraoperatively, and the SIEDH was completely removed without suboccipital craniotomy. The SOB does not present as a single straight plane but bends at an angle around the EOP and the superior nuchal lines. The OAS was negatively correlated with the ASOB. CONCLUSIONThe single supratentorial craniotomy for SIEDH is reliable and effective.

КЛІНІЧНИЙ ВИПАДОК УСПІШНОГО ХІРУРГІЧНОГО ЛІКУВАННЯ ПІДГОСТОРОЇ ЕПІДУРАЛЬНОЇ ГЕМАТОМИ ПОТИЛИЧНОЇ ДОЛІ ТА ЗАДНЬОЇ ЧЕРЕПНОЇ ЯМИ

A case of surgical treatment of the patient with parietal and occipital fossa epidural hematoma is presented. X-ray examination didn’t reveal a fracture of paretal os. MRI diagnosed parietal and posterior fossa epidural hematoma. During the craniectomy realived fracrure of the parietal os, epidural hematoma removed. The souse of the bleeding was veins-perforates of the skill. A dynamic MRI found a positive outcome. The parient withdraw on the 10 day after operation.

Management of traumatic posterior fossa epidural hematomas in pediatrics: our experience and review of the literature.

Conservative management of posterior fossa epidural hematoma in the pediatric age group has been increasingly considered in the last decade with good clinical outcomes and comparable results to surgical intervention in carefully selected patients. The purpose of this study is to evaluate the outcome of observation in the management of pediatric patients with posterior fossa epidural hematoma (PFEDH) in our tertiary hospital and present a literature review on PFEDH pediatric patients. We conducted a retrospective observational study at King Abdullah University Hospital (KAUH), a tertiary hospital in North Jordan. All pediatric patients (≤ 18years) who were admitted with a diagnosis of PFEDH from January 2010 to December 2020 were included. Demographic data, trauma type, clinical signs and symptoms on admission, CT findings, treatment type, and outcomes were collected and assessed. The outcome was measured using the Glasgow outcome scale (GOS) on discharge from the hospital. A total of 16 patients were identified and included in this study. Nine patients were managed conservatively and 7 surgically. The mean age was 7.7 ± 6years ranging from 1 to 18years. Falls were the most common cause of injury. Vomiting was the most frequent presenting symptom. Except for 1 patient, 14 patients had good outcomes with a GOS of 5. One case of mortality was seen in our series. Posterior fossa epidural hematoma is a rare clinical condition among the pediatric age group. Early and consecutive CT scans must be obtained for all suspected cases. Successful conservative management can be achieved depending on multiple factors such as hematoma thickness or volume, neurological status on admission, and other radiological findings as shown in our study. The overall prognosis was good in our patients.

Non-traumatic epidural posterior fossa hematomas in child with Sensenbrenner syndrome: a case report and literature review

Background: Posterior fossa extradural hematomas are an uncommon condition with more than half of cases appearing in the pediatric population. Although the majority of cases are caused by substantial trauma, it may also be related to systemic diseases and bleeding disorders without the history of head trauma. Case report: We present the case of a 6-year-old female affected by Sensenbrenner syndrome with a non-traumatic subacute posterior fossa epidural hematoma. The patient was surgically treated and medically discharged without further neurological alteration. This is the first report of spontaneous cerebral hematoma associated with this syndrome in the literature. A literature review of the main aspects of both topics was performed. Conclusions: Although spontaneous posterior fossa epidural hematomas are rare, clinicians should be aware and highly suspicious of this differential diagnosis in certain situations such as coagulopathies and other specific systemic diseases, as fast recognition and assertive treatment are important for better outcomes.

Traumatic posterior fossa epidural hematoma in patient with mega cisterna magna

Background: Posterior fossa extradural hematoma is unusual among head injuries and represents about 4%-7% cases of all epidural hematomas. This study presented a case of traumatic posterior fossa epidural hematoma in patients with mega cisterna magna. Case Presentation: A 32-year-old male patient was examined after a fall from 3 m height. His brain computed tomography (CT) scan showed moderate to large acute epidural hematoma present in the left side of posterior fossa measuring about 16 ml volume, 10 mm in maximal thickness, and extended upwards across the ipsilateral left transverse and adjacent sigmoid dural venous sinuses to the left occipital region. It was associated with compression on the adjacent left occipital lobe. In addition, the focal enlargement of the subarachnoid space in the posterior and interior aspect of the posterior fossa was suggestive of mega cisterna magna. The patient was admitted to the intensive care unit (ICU) and follow-up CT scan of the brain was done but no interval changes were shown. Conclusion: Epidural hematoma of the posterior fossa needs a prompt intervention. Patients who present with mega cisterna magna could have better prognosis due to the larger posterior fossa space that helps in the expansion of the hematoma.

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

ObjectiveEpidural 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. MethodsA 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. ResultsSeventeen 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. ConclusionPosterior 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.

Liquid Posterior Fossa Epidural Hematoma in Pediatric Trauma: A Single-Center Case Series.

Liquid posterior fossa epidural hematoma (LPFEH) following head trauma is uncommon, and very few such cases have been described in the literature. Eight patients with this entity and their treatments are presented here. We performed a single-institution retrospective analysis of all patients with diagnosed LPFEH over a 3-year period. Collected data included clinical history, laboratory results, treatment, and review of all imaging studies performed. Eight pediatric cases were identified with imaging findings consistent with LPFEH; no adult case was identified. Enlargement of ventricles appeared on computed tomography (CT) in six cases, and secondary epilepsy onset occurred in three cases with severe dilated ventricles. Routine hematologic and coagulation tests failed to disclose anemia or abnormal coagulation in each case. Five patients underwent burr-hole drainage of the hematoma and recovered completely. Conservative therapy was adopted in three patients for small hematomas, and hematoma enlargement was not observed in the follow-up CT scans. LPFEH is a rare subtype of traumatic epidural hematoma specifically recognized in the pediatric population. Minimally invasive burr-hole drainage is a feasible procedure for the patient with evident space-occupying effect. Coagulation dysfunction or low hemoglobin as a possible contributing factor and its role in formation of LPFEH was excluded.

The pathogenesis of delayed epidural hematoma after posterior fossa surgery

The purpose of this study was to analyze the pathogenesis of delayed epidural hematoma (EDH) after posterior fossa surgery. Non-traumatic, non-arterial origin delayed EDH after posterior fossa surgery is extremely rare. Moreover, the pathogenesis of its supratentorial extension is obscure. Between April 1997 and June 2016, over 3300 patients underwent microvascular decompression (MVD) for neurovascular compression syndrome. The medical chart of four patients with delayed EDH were retrospectively reviewed. The median time from MVD to re-CT scan was 58 h (range, 33–100). All patients underwent hematoma evacuations. Intraoperative findings during hematoma evacuation revealed only an oozing hemorrhage from the transverse sinus with no definitive bleeding focus. The patients spent a median of 21.5 days (range, 11–39) at the hospital. At the last follow-up, all patients had fully recovered without significant neurological deficits and exhibited complete relief or minimal symptoms from hemifacial spasm (HFS). Postoperative uncontrolled bleeding from the dural venous sinus can sometimes cause an insidious-onset or delayed posterior fossa EDH.

Metods of diagnostic in the head-brain injury.

Background. Injuries are 3rd in the structure of the population mortality. Over the past 15 years, mortality from injury came on second place, ahead of cancer. Traumatic brain injury is the most common damage types and ranges from 36 to 40 % of all injuries. The incidence of posterior fossa hematomas among intracranial hematomas has been reported to be 2 to 3%. Objective. The aim of the present study was to investigate the features of posterior fossa hematoma, including posterior fossa epidural hematoma, posterior fossa subdural hematoma and intracerebellar hematoma. The aim of the study was to determine the clinical features and diagnosis of severe head injuries. Methods. Analyzed the medical records of patients admitted to the Department of Neurosurgery Regional Hospital. They can be: furrow branches of the middle meningeal artery; wedge-parietal sulcus sinus; Channels diploic veins; cleft wedge - occipital synchondrosis behind the backs of the pituitary fossa; occipital-mastoid suture. Results and conclusion. With the introduction of the practice of computer and magnetic resonance imaging to diagnose damage to structures in the presence of hematomas in the posterior fossa it became much easier. Since patients are not always in a conscious state data instrumental methods of diagnosis in a very short time allow the diagnosis and differential diagnosis in injuries that are accompanied by the presence of intracranial hematomas in the posterior fossa.

Posterior fossa epidural hematomas in children: a clinical analysis of 35 cases

Objective To investigate the clinical features, imaging findings, treatment and prognosis of posterior fossa epidural hematomas in children. Methods From August 2010 to April 2015, the clinical data of 35 children with traumatic posterior fossa epidural hematoma admitted to the Department of Neurosurgery, the Affiliated Hospital of Xuzhou Medical College were analyzed retrospectively. Eighteen of them were treated conservatively 8 were treated with skull drilling and drainage. Three of which received urokinase therapy because part of residual hematoma after procedure, and 9 were treated by craniotomy. Results In 18 children treated with the conservative treatment, CT revealed that their hematomas were absorbed about 1 month or so after symptom onset. The residual hematomas <5 ml after procedure in 8 children were treated with skull drilling and drainage, and 9 were treated with craniotomy, their hematomas were removed completely after procedure. They were followed up for 4 months to 5 years. All children recovered well, without operation death and disability. Conclusions The occurrence of posterior fossa epidural hematomas in children are relatively more common. Most of them are falling and slipping injuries. The lambdoid suture separation fracture and occipital fracture are the main causes of bleeding. Headache, vomiting and disturbance of consciousness are more important for identifying the disease. Hemotomas in acute phase are easy to be liquefied. Drilling skull and drainage are safe and effective for the treatment of liquefied hematomas. The early diagnosis and appropriate treatment of posterior fossa epidural hematomas in children have good prognosis. Key words: Hematoma, epidural, cranial; Child; Treatment

Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage.

A Christmas Shopping Complication: Traumatic Epidural Hematoma Leading to Cerebral Sinus Thrombosis

A 3-year-old girl tried to climb out of a shopping cart to explore the Christmas sales. She fell approximately 2.5 feet, hit the back of her head, and began to cry. Overnight, she developed nausea and vomiting and was brought to the emergency department. She was irritable but was moving all extremities, with no headache or focal neurological deficits. Initial computed tomography scan revealed a right posterior fossa epidural hematoma compressing the right transverse sinus. The sigmoid sinus, which was not compressed by the hematoma, demonstrated the abnormal computed tomography hyperdensity, lack of magnetic resonance imaging enhancement, and loss of signal on magnetic resonance imaging venography consistent with thrombosis (Fig 1).

Acute Posterior Fossa Epidural Hematoma in a Newborn Infant With Menkes Disease

Epidural hematoma (EDH) in newborn infants is rare compared with other types of intracranial hemorrhages. Furthermore, posterior fossa EDH is extremely rare. We present a case of posterior fossa EDH in an infant with Menkes disease with accessory bones in the occiput. A male infant with a condition diagnosed with Menkes disease by prenatal testing was born at 39 weeks via vacuum extraction. The patient presented with a mild tremor at 2 days after delivery. A brain computed tomography (CT) scan showed an acute EDH in the posterior fossa, extending into the occipitoparietal area. Three-dimensional CT and bone window CT scan revealed several accessory bones, diastasis of 1 accessory suture, a communicated fracture, and a linear fracture in the occipital bone. Furthermore, a bone fragment from a communicated fracture displaced toward the inside. The patient was treated conservatively for EDH because of his good general condition. The hematoma gradually resolved, and his tremor did not recur. We suggest the following mechanism of posterior fossa EDH development in our patient: (1) external force was applied to the occiput inside the birth canal during delivery, resulting in diastasis; (2) a communicated fracture occurred, and a bone fragment displaced toward the inside (linear fracture was caused indirectly by the force); (3) a transverse sinus was injured by the fragment; and (4) EDH developed in both the posterior fossa and supratentorial region. Copper deficiency can also cause fragility of connective tissues, vessels, and bones.

Treatment of posterior fossa epidural hematomas in children by drilling skull: reports in 12 cases

Objective To introduce the diagnosis and treatment of posterior fossa epidural hematomas of 12 cases in children.Methods 12 children who admitted into Tianjin Huanhu Hospital from 2008 to 2012 with posterior fossa epidural hematomas were evaluated.Through continuous review of head CT,epidural hematoma was found that manifested as isodense or mixed density in early period,and all patients were treated with cranial -pricking,hematoma aspiration without drainage tube.Results All patients recoverd well,there was no delayed hematoma,no serious complications and death.Condusion The early clinical symptoms of posterior cranial fossa epidural hematoma is mild and not specific,but enlarge of the hematoma is a serious threat to life,so consequent review of head CT is necessary.The hematoma is often liquid in early stage,and the method of cranial - pricking can be used.But the timing of surgery,surgical indications and contraindications should be strictly controlled. Key words: Epidural hematoma; Posterior fossa; Child; Cranial - pricking