title: Retroclival epidural hematomas: a clinical series.
abstract: 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.
authors.affiliation: Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.forename: Todd
authors.initials: T
authors.lastname: Hankinson
authors.forename: Curtis
authors.initials: C
authors.lastname: Rozzelle
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Blount
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Cohen-Gadol
mesh_terms: 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