Posterior Fossa Extradural Hematoma Research Articles

Supra- and Infratentorial Extradural Hematoma: A Series of Three Cases with Literature Review

AbstractThe extradural hematoma (EDH) of the posterior fossa is a rare clinical condition in head injury cases. The posterior fossa extradural hematoma (PFEDH) contributes to not more than 4 to 8% of all the EDH encountered in traumatic brain injury. The limited volume of the posterior fossa leads to early clinical deterioration and, if not subjected to timely intervention, may be fatal. This rapid deterioration is because of significant compression over the brainstem and cervicomedullary junction as well as obstructive hydrocephalus. The PFEDHs are often associated with fracture of the occipital bone, which may lead to the extension of hematoma in the supratentorial and infratentorial spaces. The traumatic supra- and infratentorial EDH (TSIEDH) constitutes less than 2% of all the EDH. Limited literature is available regarding TSIEDH, and the majority are in the form of isolated case reports. We share our experience of three cases over the last 5 years from a tertiary care referral institute with a literature review of TSIEDH. Two of these cases were managed nonoperatively, and one underwent surgical evacuation of hematoma. In the present study, we share our experience regarding prompt diagnosis and management of this particular subset of traumatic brain injury patients. We also describe the surgical technique for evacuation of TSIEDH. Early diagnosis and prompt surgical intervention can be life-saving as these hematomas may have a benign clinical presentation but rapid clinical deterioration.

Institutional Experience of Post-Traumatic Posterior Fossa Extra Dural Hematoma: A Prospective Longitudinal Study.

To analyze clinical and imaging characteristics of post-traumatic posterior fossa extradural hematoma (PFEDH). Between 2018 and 2022, 51 patients were admitted to our tertiary care trauma center with a diagnosis of PFEDH. The management decision was tailored by an individual consultant based on clinicoradiological findings. We did a prospective analysis of patient characteristics, radiology, clinical presentation, management, and outcome at discharge and onemonth follow-up. Of the 51 patients diagnosed with a PFEDH, 45 (88.2%) were male, and six (11.8%) were female with a mean age of 31.2 years (range 2-77 years). Twenty-six patients needed surgical evacuation of the EDH, while the rest 25 patients were managed conservatively. There was one crossover patient from the conservative to the surgical arm. Road traffic accidents (RTA) were the most common cause of injury (n=35; 68.6%), followed by falls from height (n=16; 31.4%). Most patients presented with vomiting and loss of consciousness (LOC). At presentation, 30 patients (58.5%) had a GCS 15. Seven patients (13.7%) presented with a GCS of 9-14, and 14 patients (27.5%) with GCS ≤ 8. The mean EDH volume in conservatively and surgically managed patients was 14.1 and 25.1cc, respectively. Five patients (9.8%) had significant midline shift with obliteration of basal cisterns, 15 patients (29.4%) had effacement of the fourth ventricle, and 11 patients (21.5%) had the presence of hydrocephalus. All patients with features suggestive of tight posterior fossa (hydrocephalus, obliterated basal cisterns, and fourth ventricle compression) needed surgical intervention. Of the 25 conservatively managed patients, 24 (96%) had favorable GOS scores at discharge, while one (4%) had an unfavorable score. 16/26 (61.5%) surgically treated patients had a good outcome at discharge (GOS=4-5), while ten patients (38.4%) had adverse outcomes (GOS < 4). Initial EDH volume was inversely correlated with presenting GCS and GOS with a mean volume of 21.5 ± 8.5 cc in patients presenting with a GCS ?8. Patients with a GCS of 15 at presentation had a mean EDH volume of 16.1 ± 8.2 cc. Patients with smaller EDH had much higher GOS scores than patients with higher volume EDH (GOS 1 = 22.0 ± 9.83 cc vs. GOS 5 = 18.9 ± 12.2 cc). Outcomes mainly depended on factors like GCS at arrival and associated supratentorial, thoracic/ abdominal polytrauma. In patients with a clot volume of < 15 cm3 and GCS of 15 at presentation with no mass effect and absence of tight posterior fossa, a conservative trial under strict clinicoradiological monitoring in a neuro-critical multidisciplinary setting can be offered with good results. In cases of altered GCS, findings of a TPF, or clinicoradiological deterioration, immediate surgery is warranted.

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.

Posterior fossa extradural hematoma - clinical presentation and outcome

Background: Posterior Fossa Extra Dural Hematoma (PFEDH) is a rare entity but certain crucial structures are supposed to be injured. Because of limited space in the posterior fossa, a clinical small volume of hematoma can deteriorate patients. Therefore timely diagnosis and prompt intervention are required.&#x0D; Objective: This study is done to analyse factors like demographic profile, mode of injury, clinical features in relation to PFEDH and its management and how they influence the outcome.&#x0D; Materials &amp; methods: This is a retrospective analysis of patients who presented with PFEDH from July 2016 to July 2021 at RNT Medical College and M.B. group of Hospitals Udaipur, India. Patients were evaluated on the basis of demographic profile, mode of injuries, GCS on admission &amp; discharge, and associated radiological findings.&#x0D; Result: A total of 25 patients with PFEDH were included in this study. Amongst these, 18 (72%) were males, and10 (40%) were less than 18 years of age. On admission 19 (76%) had GCS 13-15.22 (88%) patients underwent surgery and 3 (12%) were planned for conservative management. At 6-month follow-up, 22 (88%) patients had good outcomes with GOS 3-5 and 1 was lost to follow up while 2 (8%) had poor outcomes with GOS 1-2.&#x0D; Conclusion: GCS on admission is a good predictor of outcome. The volume of EDH was one of the key factors in deciding the line of management. PFEDH can sometimes be rapidly fatal due to expansion of hematoma and compression of posterior cranial fossa space which leads to brain stem compression therefore time management is the most important factor for a good outcome.

THE PREVALENCE AND CLINICAL PROFILE OF PATIENTS PRESENTED WITH POSTERIOR FOSSA EXTRA DURAL HEMATOMA IN TERTIARY CARE HOSPITAL: A RETROSPECTIVE OBSERVATIONAL STUDY.

Aim: to determine the prevalence and clinical profile of patients presented with posterior fossa extra dural hematoma.&#x0D; Materials and Methods: The present retrospective observational study was conducted in the Department of Neurosurgery, SKMCH, Muzaffarpur, Bihar, India. The records were retrospectively analyzed for clinical presentation, admission Glasgow Coma Scale (GCS), mode of injury, type of intervention and postoperative outcome. Outcomes were assessed on the basis of Glasgow Outcome Score (GOS) at the time of discharge and at 3 months&#x0D; Results: Of these 39 patients, 28 were males and 11 females. The mean age of patients was 29.21 years. 24 patients had GCS 13-15 at admission followed by 9 with GCS 9-12 and only 5 of them had GCS &lt;9 at admission. Mean EDH volume was 28.7 ml. 36 patients were operated, 5 patients managed conservatively.&#x0D; Conclusion: The posterior fossa is an uncommon site for epidural haematomas. Due to the small volume of the posterior fossa and contained important structures mortality can be high if the haematoma is missed. Clinical progress is silent and slow, but the deterioration is sudden and quick to become fatal if not promptly treated. Early recognition is extremely important.&#x0D; Keywords: Extradural hematoma, Posteriors fossa, GCS, Trauma

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.

Patterns and outcomes of posterior fossa extradural hematoma-six years study in emergency hospitals of Erbil city

Background and objectives: Posterior fossa extradural hematoma is rare , however, in clinical practice it may represent a top emergency. The aim of study was to find the proportion of posterior fossa extradural hematoma to other extradural hematomas, its age incidence, main causes and factors that affect surgery and outcomes. Methods: Thirty-five cases of posterior fossa extradural hematoma were diagnosed and treated over 6 years period, from 2012 to 2018. The patients were evaluated regarding age, type of trauma, cranial computer tomography, Glasgow coma scale score, treatment and follow-up over the period of 3 months. Results: Thirty-five patients (1.8%) with posterior fossa extradural hematoma were treated. Their mean age + SD were 16.81 + 14.58 years, ranging from 2 to 65 years. The causes of head trauma in a decreasing order were fall from height (57.1%) (Twenty patients), and road traffic accident (42.9%) (Fifteen patients). Glasgow coma scale score was 13-15 in the majority (62.9) (twenty-two cases). About fifty-four point three percent were treated conservatively, and surgical intervention was done in forty-five point seven percent. Around sixty- five point seven percent were alive without deficit, and only five point seven percent died. Among those with hematoma (&lt; 10 mL), sixteen patients were alive without deficit compared with seven with (&gt; 10 mL). The proportion of alive patients without deficit were treated conservatively (seventeen patients) compared with six patients treated surgically.

Traumatic Posterior Fossa Extradural Hematoma–Experience at a Tertiary Care Centre

Traumatic Posterior Fossa Extradural Hematoma–Experience at a Tertiary Care Centre

Traumatic Posterior Fossa Extradural Hematoma: Experience at Level I Trauma Center.

Introduction:Posterior fossa extradural hematoma (PFEDH) is rare among the traumatic brain injury and represent about 4–7% cases of all EDHs. This rare condition is rapidly fatal unless identified and intervened timely. Because of limited space in posterior fossa, comparatively small volume can cause clinical deterioration. Early diagnosis by cranial computed tomography and emergent evacuation is vital for a good outcome.Materials and Methods:This study was conducted at Level I trauma center at All India Institute of Medical Sciences, New Delhi, India. Hospital medical records were reviewed from September 2007 to June 2015. There were 856 cases of acute EDHs and of these 69 cases had PFEDHs. Records of patients with PFEDHs were reviewed for the mode of injury, Glasgow Coma Scale (GCS) at admission, imaging, type of intervention, outcome, and follow-up. GCS was assessed at 6 months and 12 months follow-up. Pertinent literature is reviewed.Results:Of these 69 patients, 51 were males and 18 females. The mean age of patients was 28.6 years (range 4–43 years). Forty-three patients had GCS 15 at admission, and only 4 of them had admission GCS <8. Mean EDH volume was 29.2 ml. Sixty-six patients were operated, three managed conservatively. Sixty-seven patients were discharged, of which, 56 (81.1%) had GCS 15. Two patients died. Most common associated injuries were long bone fractures (18, 26.1%) followed by blunt injury thorax (11, 15.9%). Mean follow-up duration was 69.2 months (range 6–94 months). At 6 months follow-up, 61 (88.4%) patients had good recovery (Glasgow Outcome Score [GOS] 5) and at 12 months, 62 (89.8%) had GOS 5.Conclusion:PFEDH are rare. They are usually associated with occipital bone fractures and may also have a supratentorial hematoma. It may be rapidly fatal due to the expansion of hematoma and compromise of the posterior cranial fossa space leading to brainstem compression, tonsillar herniation, and/or obstructive hydrocephalus. Early diagnosis and emergent evacuation lead to good outcome.

Endoscopically assisted supratentorial evacuation of infratentorial epidural hematomas crossing the transverse sinus

Abstract Objective Traumatic posterior fossa extradural hematoma (TPFEDH) is a serious complication of cranial injury and the orthodox technique for removal of TPFEDH encompasses a suboccipital craniectomy or craniotomy. However, in some cases, the TPFEDH might extend to the supratentorial space, thus appearing to be crossing the transverse sinus. Contrary to the standard way, a modified supratentorial transoccipital approach may be better suitable in the management of this subtype of TPFEDH. Methods The clinical data of 34 consecutive patients in which the TPFEDH was crossing the transverse sinus were prospectively assessed. We operated all the parents using the supratentorial transoccipital approach via supratentorial liner incision. The supratentorial extradural hematoma (EDH) was evacuated and the endoscope was used to fully evacuate the infratentorial compartment. Glasgow Coma Scale at discharge (dGCS) was documented and Glasgow Outcome Scale score (GOS) was measured at 3–15 months (mean = 5.4 months) follow-up subsequently. Results The average operation time was 44 min (30–60 min). The blood loss was so minimal that the intraoperative blood transfusion was unnecessary for all the patients. Complete hematoma removal was achieved on all the patients. The average dGCS and GOS were 14 and 4.9 respectively. One case suffered from primary brain stem injury whose GOS scored only 3 on follow up. There was no surgery related mortality at discharge and during the follow-up. Conclusion This is the first case series to demonstrate the removal of TPFEDH crossing the transverse sinus via the modified supratentorial transoccipital craniotomy. This approach was proven to be more effective in managing such cases.

Factors affecting outcome in posterior fossa EDH: an analytical study at tertiary referral hospital

AbstractIntroduction. Posterior fossa extradural hematomas (PFEDHs) are uncommon as compared to supratentorial EDH and these patients can deteriorate very rapidly due to compression over brainstem. Thus early identification and intervention can save the lives of these patients.Methods. We prospectively studied 114 patients of posterior fossa injury for mode of injury, neurological status during admission, radiological findings, management, and outcomes of patients suffered posterior fossa extradural hematoma. All statistical analyses were determined using the SPSS 22.0.0.0 version. Statistical analysis was conducted utilizing Chi-square test.Results. Out of 114 posterior fossa trauma patients 28 patients (24.56%) having posterior fossa EDH. GCS on admission (p value=0.002), volume of posterior fossa EDH (p value= 0.000) were significant factors for the outcome of posterior fossa EDHs. On comparing the data patients who survived and those who did not survive, the GCS on admission (p value=0.004) and brain stem compression (p value=0.000) were two factors found to affect the mortality significantly.Conclusion. Early detection with high degree of suspicion and immediate evacuation of PFEDHs should be done if causing fourth ventricle, basal cistern or brain stem compression.

Traumatic posterior fossa extradural hematoma: case report and review of literature

Traumatic posterior fossa extradural hematoma (PFEDH) is rare lesion constituting less than 10% all extradural hematomas. Reliance on clinical findings alone is not recommended as these are nonspecific; it is advisable to conduct a computerized tomography (CT scan) of brain. The recommended treatment for traumatic posterior fossa extra dural hematoma is surgical evacuation soon after diagnosis because the posterior fossa contains vital structures. There have been an increasing number of cases of traumatic posterior fossa extra dural hematoma treated conservatively with good results both in children and in adults. The decision between surgery and observation is still controversial. In this article we present our experience in treating patients with traumatic PFEDH and discuss risk factors and outcome.

Posterior fossa extradural hematoma: our experience and review of the literature

Background Posterior fossa EDH is an uncommon entity, accounting for only 4% to 12.9% of all EDHs It has a characteristic clinical presentation, which if detected can be life-saving. Methods We sought to study the demographic features of patients with PFEDH and assess the clinical and radiologic predictors of the outcomes of as well as evaluate the various treatment modalities for this disease. We carried out a retrospective analysis of the cases of 61 patients with PFEDH who were admitted to the National Institute of Mental Health and Neurosciences (Bangalore, India) from 1991 through 2002. We analyzed various parameters and applied Fisher's exact test for statistical analysis. Results Mostly male individuals were affected with PFEDH. Their GCS score at admission and the presence of hydrocephalus as detected by CT scan determined the outcome of the patients. The children had better outcomes than did the adults. Patients with a good GCS score could be managed conservatively. Conclusions Posterior fossa EDH is rare. The PF is an unfavorable location of a hematoma. Good GCS scores have a favorable prognosis. Children have better outcomes than do adults, and the presence of hydrocephalus on CT scan is an ominous sign.

Concomitant post-traumatic craniospinal multicompartmental hematoma associated with posterior fossa extradural hematoma — Case report and review of literature

BACKGROUND: Spinal epidural hematomas following trauma are rare. There are few case reports in literature of concomitant cranial and spinal hematomas following trauma. We report a patient who presented with concomitant post traumatic cranial and spinal epidural, subdural and subarachnoid hematomas. Imaging of the upper cervical spine in patients with posterior ossa fractures and hematomas is advisable. Surgical evacuation of the hematomas is safer and would relieve symptoms.

Posterior fossa extradural hematoma.

To review the clinical profile, radiology and treatment of Pediatric posterior fossa extradural hematoma (PPFEDH) and evaluate the outcome. Posterior fossa extradural hematoma (PFEDH) is an uncommon trauma sequel and in pediatric age group is still rare. This article discusses 18 cases of PPFEDH seen over a period of 8 years and review the pertinent medical literature. Only a few studies discuss PPFEDH and in most of them outcome has been good. Trauma has been subtle and fracture of occipital bone is seen in majority of cases. Treatment has been operative in majority of the cases. Most of the patients were diagnosed only on high index of suspicion with a history of trauma on the occipit, fracture of the occipital bone and persistent symptoms suggestive of increasing intracranial pressure and posterior fossa space occupying lesion. CT scanning was done liberally to confirm the suspicion and the patients with hematoma were treated aggressively by surgical evacuation with good recovery in most of them. Authors suggest an aggressive approach in the event of PPFEDH. However some patients can be managed conservatively but they should be closely observed for clinical manifestation and CT scan routinely to evaluate the progress of hematoma radiologically. A strict criterion should be followed in choosing such patients for conservative treatment as highlighted in the study.

Angiographic demonstration of the bleeding point in a posterior fossa extradural hematoma. Case report.

✓ In a case of posterior fossa extradural hematoma, vertebral angiography demonstrated the bleeding point on the occipital branch of the vertebral artery.

Double lucid interval in patients with extradural hematoma of the posterior fossa.

✓ The classic clinical sequence in posterior fossa extradural hematoma is head injury, lucid interval, deterioration; the deterioration is usually terminated by death or surgical intervention. This report emphasizes a syndrome characterized by a double lucid interval in which the phase of deterioration terminates spontaneously with improvement. This is actually only a second lucid interval and can lead surgeons into a false sense of security since it is followed by deterioration, as the clot continues to enlarge. Four such cases are described in detail. The characteristics of the initial phase of deterioration are described and contrasted with those of the deterioration following the lucid interval in the classic supratentorial extradural hematoma.

Posterior Fossa Extradural Hematoma demonstrated by Percutaneous Direct Vertebral Angiography

Posterior Fossa Extradural Hematoma demonstrated by Percutaneous Direct Vertebral Angiography