Traumatic Pediatric Posterior Fossa Extradural Hematomas: A Tertiary-Care Trauma Center Experience from India.
BACKGROUND
Traumatic posterior fossa extradural hematomas (PFEDH) are rare lesions constituting <10% of all extradural hematomas. Reliance on clinical findings alone is not recommended as these are nonspecific; for all suspicious cases, it is advisable to conduct a CT scan. Only a handful of pediatric studies have been reported analyzing the outcome of such lesions. The aim of our study was to analyze outcomes for children with PFEDH managed at our apex trauma center.


METHODS
We conducted a retrospective analysis of pediatric patients (≤18 years) admitted with a diagnosis of traumatic PFEDH from January 2008 to February 2014.


RESULTS
Of 22 patients, 16 were managed surgically (group 1) and 6 conservatively (group 2); 1 failed conservative treatment (due to an increased EDH volume). Mean age was 11.7 years (range 2-18 years). Falls were the most common cause of injury. Vomiting and loss of consciousness were the most frequent presenting features. There were 18 mild, 2 moderate and 2 severe head injuries. The mean volume of EDH was 37.1 ml (range 18-100 ml) and 10.3 ml (8-16 ml) in the operative and conservative subgroups, respectively. Occipital bone fracture was seen in 16 cases with supratentorial extension in 11. Four complications were noted in 3 cases. Mean follow-up duration was 25.1 months (range 3-34 months). Except for 1 patient, all had excellent outcomes. There was no mortality.


CONCLUSIONS
Traumatic pediatric PFEDHs are rare. Both the clinical status of the patient and the volume of the hematoma need to be assessed before deciding on surgery. Most cases have associated occipital bone fractures and around half have supratentorial extension; these need to be carefully assessed preoperatively. Torrential venous bleeding can be a major problem due to rupture of the adjacent sinuses. Timely intervention is crucial for achieving good outcome, keeping in view a low threshold for surgical evacuation. Although not innovative, this second-largest case series provides additional data and contributes to the existing literature on such lesions in pediatric patients.
G Lakshmi
GL
Prasad
Deepak Kumar
DK
Gupta
Bhawani Shankar
BS
Sharma
Ashok Kumar
AK
Mahapatra
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior; D005260:Female; D005500:Follow-Up Studies; D006407:Hematoma, Epidural, Cranial / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007194:India; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D011859:Radiography; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D014193:Trauma Centers; D016896:Treatment Outcome