Traumatic retroclival hematoma resulting in abducens nerve palsy: illustrative case
Ali Gharibi Loron1, Kevin L Webb1,2, Ryan M Naylor1
1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Posttraumatic retroclival hematomas in children can cause abducens nerve palsy, but most cases show spontaneous recovery. Higher initial Glasgow Coma Scale scores predict general neurological recovery.
Area of Science:
- Pediatric Neurosurgery
- Neurotraumatology
- Ophthalmology
Background:
- Posttraumatic retroclival hematomas are rare in children.
- These injuries can lead to cranial nerve palsies, particularly abducens nerve palsy.
- Understanding risk factors and outcomes is crucial for pediatric neurotrauma management.
Purpose of the Study:
- To systematically review the literature on pediatric posttraumatic retroclival hematomas.
- To characterize risk factors, treatment considerations, and patient outcomes.
- To report a novel case of pediatric retroclival hematoma.
Main Methods:
- Systematic literature search of Embase, Scopus, PubMed, and Web of Science (1986-2024).
- Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Analysis of 64 pediatric cases from 41 articles, plus one novel case.
Main Results:
- Abducens nerve palsy occurred in 40% of pediatric posttraumatic retroclival hematoma cases.
- Complete recovery of abducens nerve function was observed in 73% of affected patients.
- Higher initial Glasgow Coma Scale (GCS) scores correlated with general neurological recovery (p < 0.05).
Conclusions:
- Spontaneous recovery of abducens nerve function is common in pediatric posttraumatic retroclival hematoma with abducens palsy.
- Initial GCS scores predict overall neurological recovery but not abducens nerve palsy resolution.
- Factors influencing abducens nerve palsy resolution require further investigation.
Background:
Posttraumatic retroclival hematomas are rare pathologies among pediatric patients and can result in cranial nerve palsies. The authors sought to survey the literature and characterize the risk factors, treatment considerations, and overall outcomes for pediatric patients experiencing posttraumatic retroclival hematomas.
Observations:
A search of the Ovid Embase, Scopus, PubMed, and Web of Science databases from January 1986 to May 2024 was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Additionally, the authors report a novel case of pediatric retroclival hematoma. The systematic review identified 41 eligible articles describing 64 individual cases of posttraumatic clival/retroclival hematoma in pediatric patients. The incidence of abducens nerve palsy in the setting of posttraumatic retroclival hematoma was 40%, and the rate of complete recovery of abducens nerve function was 73%. Analyses revealed that a higher initial Glasgow Coma Scale (GCS) score correlated with general neurological recovery (p < 0.05). However, no significant difference was found in GCS scores between patients with complete and those with incomplete abducens nerve recovery.
Lessons:
There is a high rate of spontaneous recovery of abducens nerve function in patients with abducens palsy in the setting of posttraumatic retroclival hematoma. While initial GCS scores can predict general neurological recovery, factors influencing abducens nerve palsy resolution remain unclear. https://thejns.org/doi/10.3171/CASE24474.
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