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Traumatic posterior fossa extradural haematoma
1National Neurosurgical Referral Centre, National Academy of Medical Sciences Kathmandu, Nepal. dryamroka@yahoo.com
JNMA; Journal of the Nepal Medical Association
|December 17, 2008
Summary
Posterior fossa extradural hematomas (PFEDH) present with vague symptoms and can have a severe course. Surgical evacuation offers a high favorable outcome rate, with 81% of operated patients recovering well.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Neurology
Background:
- Posterior fossa extradural hematomas (PFEDH) are rare but serious intracranial hemorrhages.
- They are associated with vague symptoms, rapid deterioration, and obstructive hydrocephalus.
- Incidence ranges from 4-7% of all intracranial epidural hematomas.
Purpose of the Study:
- To analyze the clinical characteristics, management, and outcomes of PFEDH.
- To evaluate the effectiveness of surgical evacuation versus conservative management.
Main Methods:
- Retrospective study of 43 PFEDH cases (May 1999 - December 2005).
- Data collected on demographics, injury mechanisms, symptoms, Glasgow Coma Scale (GCS) scores, and management.
- Outcomes assessed using a dichotomized Glasgow Outcome Scale.
Main Results:
- Males predominated (98%); road traffic accidents were the main cause (80%).
- Vomiting (67%), transient loss of consciousness (48%), and headache (34%) were common symptoms.
- Favorable outcomes were achieved in 81% of surgically treated cases and 70% of conservatively managed cases, with an overall favorable outcome of 79% and 7% mortality.
Conclusions:
- PFEDH requires prompt diagnosis and management due to potential for rapid deterioration.
- Surgical evacuation is associated with a high rate of favorable outcomes.
- Conservative management can be considered for select cases with less severe presentations.
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