Related Experiment Video
Updated: Jul 26, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Fatal Distant Venous Epidural Hematoma Following Posterior Cranial Fossa Surgery in a Twelve-Year old Child
Andrea Ortiz-Ordonez1, Geovanny Jiménez-Deleg2, Saif Salman3
1Neurological Surgery, Universidad San Francisco de Quito, Colegio Ciencias de la Salud, calle Diego de Robles s/n y Pampite, 170901, Quito, ECU.
Insights
Cranial epidural hematoma can occur unexpectedly after posterior fossa surgery due to brain collapse. This serious complication, even when distant from the surgical site, can lead to severe neurological issues or death.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Neuroradiology
Background:
- Cranial epidural hematoma (CEH) is a critical neurosurgical emergency.
- It typically results from arterial or venous bleeding between the dura mater and skull.
- Posterior fossa surgery carries a risk of CEH due to potential dural detachment and brain collapse.
Observation:
- A 12-year-old child presented with symptoms of increased intracranial pressure, including headache, vomiting, and vision loss.
- Imaging revealed obstructive hydrocephalus and a posterior fossa intraventricular tumor.
- Following tumor resection, the patient developed a CEH remote from the surgical site.
Findings:
- The epidural hematoma was associated with lacerations of the superior sagittal sinus, caused by dural detachment.
- Sudden reduction in intracranial pressure post-surgery likely precipitated the dural detachment and subsequent hemorrhage.
- The patient experienced a fatal outcome due to uncontrolled intracranial pressure.
Implications:
- This case highlights the risk of delayed CEH after posterior fossa tumor resection.
- Neurosurgeons must consider the potential for CEH, especially when managing prolonged elevated intracranial pressure.
- Awareness and vigilance are crucial to prevent severe neurological deficits or mortality associated with this complication.
Abstract:
Cranial epidural hematoma is a serious event requiring immediate intervention. This can be due to sudden traction tearing the vessels between the dura and the skull. During posterior fossa surgery, brain collapse may emerge due to the sudden reduction of prolonged elevated intracranial pressure; it could cause dura-skull detachment to create epidural hematoma even far from the surgical site. Hence, we should be aware of this complication when approaching posterior fossa tumors as it frequently leads to severe neurologic impairment or death. Here, we report a 12-year old previously healthy child who was admitted with a 4-month history of severe headache, vomiting, and right eye blindness due to increased intracranial pressure. A brain Computed Tomography (CT) scan showed obstructive hydrocephalus, and contrast-enhanced Magnetic Resonance Imaging (MRI) confirmed intraventricular posterior fossa tumor. After tumor resection, the patient developed an epidural hematoma far from the surgery site. Removal of the hematoma exposed lacerations of superior sagittal sinus due to dural detachment. Failure to control intracranial pressure resulted in a fatal outcome.
