[Posterior fossa venous epidural hematoma. Based on 2 cases]

We present two rare cases of posterior fossa epidural hematoma (PFEH) due to occipital fracture and tearing of transverse sinus. One of the patients showed supratentorial and infratentorial extension, which is found in half of the PFEH cases. Both cases experienced clinical worsening within 48 h of the head injury, with control CT showing increase of haematoma volume. Both patients were elected for surgery consisting of suboccipital craniectomy, control of sinus bleeding and sealing of epidural space with dural fixation. Sources of bleeding of PFEH are, by order of frequency, transverse sinus, small dural arteries and sigmoid sinus. PFEH may cause fatal clinical outcome with less volume than supratentorial ones. PFEH have high mortality if not treated. Patients with PFEH and GCS <15 should be admitted to hospital and a control CT should be done if there is deterioration or in the first 24 hours. The treatment of choice is surgery, conservative therapy being an alternative for small PFEH and good clinical evolution.