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Published on: February 29, 2020
Epidural hematoma after cochlear implantation in a 2.5-year-old boy
Jan Gosepath1, Jan Maurer, Wolf J Mann
1Department of Otolaryngology-Head and Neck Surgery, University of Mainz, School of Medicine, Mainz, Germany. gosepath@hno.klinik.uni-mainz.de
Insights
A rare epidural hematoma complication occurred after cochlear implantation in a child. Prompt neurosurgical intervention and intensive care led to a full recovery without neurological deficits.
Area of Science:
- Neurosurgery
- Otolaryngology
- Pediatrics
Background:
- Cochlear implantation is a vital procedure for profound sensorineural hearing loss.
- Early diagnosis and management of complications are crucial for patient outcomes.
Observation:
- A 2.5-year-old boy developed an extensive epidural hematoma post-cochlear implantation, leading to intracranial compression and midline shift.
- The complication was followed by arterial infarction affecting multiple cerebral arteries, likely due to tentorial incarceration.
Findings:
- Immediate neurosurgical intervention, intensive care, low-dose anticoagulation, and high-dose corticosteroids were administered.
- The child experienced a complete recovery within 3 weeks, with no residual neurological deficits.
Implications:
- Epidural hematoma is an extremely rare but life-threatening complication of cochlear implantation, particularly with extensive bone work.
- Awareness and preparedness for managing such rare complications are essential in cochlear implant surgery.
Objective:
Report a case of an epidural hematoma after cochlear implantation in a 2.5-year-old boy, the diagnostic and therapeutical emergency management, as well as the postinterventional course and rehabilitation of the child.
Study Design:
Retrospective case review.
Patient:
Two and a half-year-old boy, suffering from early onset, profound sensorineural hearing loss had been diagnosed at an age of 1.5 years, which had been more severe on the right side initially, but had progressed to bilateral deafness. INTERVENTION AND COMPLICATION: Cochlear implantation on the left side, followed up by an extensive epidural hematoma, causing intracranial compression with a midline shift of 15 mm to the right side. This initial complication was followed up by arterial infarction not only of the middle but also the posterior as well as the anterior cerebral artery, most likely caused by incarceration through the tentorium.
Results:
After immediate neurosurgical intervention and intensive care treatment including low-dose anticoagulation and high doses of corticosteroids, the child recuperated completely within 3 weeks without any remaining neurologic deficits.
Conclusion:
In cochlear implantation, especially if placement of the implant housing is associated with considerable bone work, epidural hematoma has to be considered as an extremely rare, but life-threatening, complication.
