Posterior fossa extradural haematomas

Posttraumatic epidural haematoma (EDH) of the temporal region is the most common site of supratentorial extradural bleeding; other locations are considered atypical. We reviewed 24 patients with EDH located in the posterior cranial fossa (PFEDH) treated at two neurosurgical centres between January 2000 and November 2006.

In the retrospective study we analysed gender and age distribution, type of injury, clinical presentation, Glasgow Coma Scale (GCS) score on admission, radiological images, interval between trauma and surgery, and outcome.

24 patients with PFEDH constituted 11.5% of 209 surgically treated individuals with EDH. The best outcomes were obtained by patients with GCS scores of 15-14 on admission. Patients in the fourth to seventh decade of life had less favourable outcomes than younger ones. More than half of the patients with PFEDH had associated intradural lesions. Only patients with concomitant brain contusion had a more favourable recovery. The 3 worst levels on the Glasgow Outcome Scale (GOS) were observed in patients suffering from subdural or intracerebral haematoma, or both, associated with the PFEDHs. The majority of patients with concurrent lesions and supratentorial extension of the haemorrhage were in the subgroup undergoing craniotomy between 24 and 72 h after injury. Patients treated in this time interval also had the most unfavourable outcomes. A classical lucid interval was observed only in one patient. The mortality rate in the series was 4.2%.

The most significant factors influencing outcome in our patients were GCS on admission, age, and associated intradural lesions.