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Posterior fossa extradural hematoma
P K Gupta1, A K Mahapatra, S D Lad
1Department of Neurosurgery, National Neurosurgical & Trauma Center, Khoula Hospital, Muscat, Sultanate of Oman. kratika@omantel.net.om
Insights
Pediatric posterior fossa extradural hematoma (PPFEDH) is rare but requires prompt diagnosis and aggressive surgical treatment for good outcomes. Close observation and CT scans are vital for conservative management cases.
Area of Science:
- Pediatric Neurosurgery
- Trauma Management
- Neuroradiology
Background:
- Pediatric posterior fossa extradural hematoma (PPFEDH) is a rare consequence of head trauma in children.
- Often associated with subtle trauma and occipital bone fractures.
- Limited literature exists on PPFEDH, with most studies reporting favorable outcomes.
Purpose of the Study:
- To review the clinical presentation, radiological findings, and treatment strategies for PPFEDH.
- To evaluate the outcomes of pediatric patients with PPFEDH.
- To assess the efficacy of aggressive surgical intervention versus conservative management.
Main Methods:
- Retrospective analysis of 18 pediatric cases of PPFEDH over 8 years.
- Review of relevant medical literature on PPFEDH.
- Clinical assessment, CT scanning, and surgical or conservative management based on patient condition.
Main Results:
- Diagnosis often relies on high clinical suspicion, trauma history, occipital fractures, and symptoms of increased intracranial pressure.
- CT scanning is crucial for confirming the diagnosis.
- Majority of patients underwent surgical evacuation with good recovery.
Conclusions:
- An aggressive surgical approach is recommended for PPFEDH.
- Conservative management is possible for select cases but requires close clinical and radiological monitoring (CT scans).
- Strict criteria should be applied when selecting patients for conservative treatment.
Objective:
To review the clinical profile, radiology and treatment of Pediatric posterior fossa extradural hematoma (PPFEDH) and evaluate the outcome.
Methods:
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.
Results:
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.
Conclusion:
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.