Retroclival epidural hematomas: a clinical series.
BACKGROUND
Retroclival epidural hematomas (REDHs) are infrequently reported. To our knowledge, only 19 case reports exist in the literature.


OBJECTIVE
This study was performed to better elucidate this pathology.


METHODS
We prospectively collected data for all pediatric patients diagnosed with REDH from July 2006 through June 2009. Data included mechanism of injury, Glasgow Coma Scale score, neurological examination, treatment modality, and outcome. Magnetic resonance imaging was used to measure REDH dimensions.


RESULTS
Eight children were diagnosed with REDH, and the hematomas were secondary to motor vehicle-related trauma in all cases. The mean age of patients was 12 years (range 4-17 years). The mean REDH height (craniocaudal) was 4.0 cm, and the mean thickness (dorsoventral) was 1.0 cm. At presentation, the mean Glasgow Coma Scale score was 8 (range 3-14), and there was no correlation between hematoma size and presenting symptoms. Two patients died soon after injury, and 2 additional patients had atlanto-occipital dislocation that required surgical intervention. No patient underwent surgical evacuation of the REDH. The mean follow-up was 14 months. At most recent follow-up, 4 patients are neurologically intact, 1 patient has a complete spinal cord injury, and 1 patient has mild bilateral abducens nerve palsy.


CONCLUSIONS
To our knowledge, this study of 8 pediatric patients is the largest series of patients with REDH thus far reported. Based on our study, we found that REDH is likely to be underdiagnosed, atlanto-occipital dislocation should be considered in all cases of REDH, and many patients with REDH will have minimal long-term neurological injury.
Tubbs
R Shane
RS
Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA.
Griessenauer
Christoph J
CJ
Hankinson
Todd
T
Rozzelle
Curtis
C
Wellons
John C
JC
Blount
Jeffrey P
JP
Oakes
W Jerry
WJ
Cohen-Gadol
Aaron A
AA
D020434:Abducens Nerve Diseases / Q000209:etiology; D000063:Accidents, Traffic; D000293:Adolescent; D001269:Atlanto-Occipital Joint / Q000293:injuries / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D004204:Joint Dislocations / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome