title: Treatment of traumatic acute posterior fossa subdural hematoma: report of four cases with systematic review and management algorithm.
abstract: BACKGROUND
  Traumatic posterior fossa subdural hematomas (SDHs) are rare lesions. Despite improvements in intensive care and surgical management of traumatic brain injuries over the last decades, the outcome for posterior fossa subdural hematomas remains poor.
  
  
  METHODS
  We conduct a retrospective study over a 2-year period of patients sustaining traumatic brain injury and posterior fossa SDH. Additionally, a systematic review of case series published to date was performed.
  
  
  RESULTS
  The incidence of posterior fossa SDH was 0,01% (4/326). All patients in this current series had poor prognosis. Three out of four exhibited ischemic/edema lesions in postoperative CT scans leading to fourth ventricle effacement and persistent brainstem compression. Our literature review retrieved 57 patients from only seven case series. Unfavorable outcomes were seen in 63% of patients.
  
  
  CONCLUSIONS
  Our data and data from the literature do not provide sufficient evidence to establish an optimal treatment strategy for posterior fossa SDH. However, based on lessons learned with these four cases, together with results from review of the literature, we propose an algorithm for the management of this rare condition.
authors.affiliation: Division of Neurosurgery, Hospital Das Clínicas University of Sao Paulo Medical School, São Paulo, SP, Brazil, amorim.robson@gmail.com.
authors.forename: Robson Luis Oliveira
authors.initials: RL
authors.lastname: de Amorim
authors.forename: Shirley I
authors.initials: SI
authors.lastname: Stiver
authors.forename: Wellingson Silva
authors.initials: WS
authors.lastname: Paiva
authors.forename: Edson
authors.initials: E
authors.lastname: Bor-Seng-Shu
authors.forename: Hugo
authors.initials: H
authors.lastname: Sterman-Neto
authors.forename: Almir Ferreira
authors.initials: AF
authors.lastname: de Andrade
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
mesh_terms: D000328:Adult; D000465:Algorithms; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult