title: The management of birth-related posterior fossa hematomas in neonates.
abstract: BACKGROUND
  Symptomatic posterior fossa hematoma in the term newborn is rare.
  
  
  OBJECTIVE
  To report on the management and outcome of posterior fossa subdural hematoma (PFSDH) in neonates.
  
  
  METHODS
  A retrospective analysis of the department database and clinical notes of neonates admitted since 1985 with a PFSDH was performed together with a literature review of similar case series.
  
  
  RESULTS
  Sixteen patients were included. The median gestational age was 40 weeks with a high proportion of primiparous mothers (n = 9) and forceps delivery (n = 9). Nine neonates had symptoms of brainstem dysfunction within the first 24 hours of life, whereas the other 7 had a delayed presentation (median 4 days) with signs of raised intracranial pressure due to hydrocephalus. Each patient had a cranial ultrasound followed by computed tomography scan that showed the PFSDH. Eleven neonates required surgical evacuation of the PFSDH, whereas hydrocephalus was managed by transient external ventricular drainage in 2 further patients. Eventually, 2 neonates required a permanent ventriculoperitoneal shunt. Five neonates had no operative intervention. With a mean follow-up of 7.8 years, 2 patients had mild developmental delay and 1 had severe developmental delay. The 13 other patients had a normal development.
  
  
  CONCLUSIONS
  In neonates with a PFSDH, surgery can be safely performed in those who have clinical and radiological signs of brainstem compression or hydrocephalus. A small number of neonates require a ventriculoperitoneal shunt in the long term. Initial aggressive resuscitation should be performed even in cases of initial severe brainstem dysfunction because of the good long-term neurological outcome.
authors: AP-HP, Hôpital Necker Enfants Malades, Department of Pediatric Neurosurgery, Paris, France. thomas.blauwblomme@nck.aphp.fr
authors: Thomas
authors: T
authors: Blauwblomme
authors: Matthew
authors: M
authors: Garnett
authors: Estelle
authors: E
authors: Vergnaud
authors: Nathalie
authors: N
authors: Boddaert
authors: Marie
authors: M
authors: Bourgeois
authors: Federico
authors: F
authors: Dirocco
authors: Michel
authors: M
authors: Zerah
authors: Christian
authors: C
authors: Sainte-Rose
authors: Stéphanie
authors: S
authors: Puget
mesh_terms: D003388:Cranial Fossa, Posterior / Q000601:surgery*; D005260:Female; D006408:Hematoma, Subdural / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D007231:Infant, Newborn; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome