Clinicoradiologic Predictors of Outcome of Posterior Fossa Extradural Hematoma: An Institutional Experience

Abstract

Introduction Posterior fossa extradural hematomas (PFEDH) comprise 4 to 7% of all intracranial extradural hematomas (EDHs).

Material and Methods A prospective study of 25 patients who presented with PFEDH was conducted in PGIMER, Dr. Ram Manohar Lohia (RML) Hospital, New Delhi in department of neurosurgery from January 2011 to July 2012. The patients were analyzed in relation to age, sex, mode of injury, Glasgow coma scale (GCS) at the time of presentation, computed tomography findings of the head, and therapeutic outcome. Duration of follow-up was 6 months.

Results In the authors’ study, male-to-female ratio was 22:3. Age range was 6 months to 62 years and mean age was 23.70 years. Mode of trauma was fall from height in 12 patients, road traffic accident (RTA) in 12, and assault in 1. Most patients had acute course (80%) followed by subacute course (20%). GCS was between 8 and 15. Fracture was associated in 21 patients out of 25. Associated intracranial injury was present in 22 patients.

Conclusion In this series, PFEDH is a result of direct impact injury as 88% of patients had overlying fracture. PFEDH should be suspected in patients who have got external injury to the occiput as it is commonly associated with formation of extradural hematoma in the posterior fossa. The neurologic status and outcome were associated with GCS, volume of hematoma, and associated intracranial injury. PFEDH rarely occurs as an isolated injury.

Keywords

extradural hematoma - posterior fossa extradural hematoma - computed tomographic scan - Glasgow coma scale - Glasgow outcome scale

• References

• 1 Mahapatra AK, Vaid VK. Rajkumar. Extradural hematomas. In: Ramamurthi R, Tandon PN. eds. Ramamurthi & Tandon's Textbook of Neurosurgery. 3rd ed.. New Delhi, India: Jaypee Brothers; 2012: 440-445
• 2 Roka YB, Kumar P, Bista P, Sharma GR, Adhikari P. Traumatic posterior fossa extradural haematoma. JNMA J Nepal Med Assoc 2008; 47 (172) 174-178
• 3 Asanin B. Traumatic epidural hematomas in posterior cranial fossa. Acta Clin Croat 2009; 48 (01) 27-30
• 4 Dirim BV, Orük C, Erdoğan N, Gelal F, Uluç E. Traumatic posterior fossa hematomas. Diagn Interv Radiol 2005; 11 (01) 14-18
• 5 Gupta PK, Mahapatra AK, Lad SD. Posterior fossa extradural hematoma. Indian J Pediatr 2002; 69 (06) 489-494
• 6 Malik NK, Makhdoomi R, Indira B, Shankar S, Sastry K. Posterior fossa extradural hematoma: our experience and review of the literature. Surg Neurol 2007; 68 (02) 155-158 discussion 158
• 7 Mahajan RK, Sharma BS, Khosla VK. et al. Posterior fossa extradural haematoma—experience of nineteen cases. Ann Acad Med Singapore 1993; 22 (03) Suppl) 410-413
• 8 Bor-Seng-Shu E, Aguiar PH, de Almeida LemeRJ, Mandel M, Andrade AF, Marino Jr R. Epidural hematomas of the posterior cranial fossa. Neurosurg Focus 2004; 16 (02) ECP1
• 9 Bozbuğa M, Izgi N, Polat G, Gürel I. Posterior fossa epidural hematomas: observations on a series of 73 cases. Neurosurg Rev 1999; 22 (01) 34-40
• 10 Pozzati E, Tognetti F. Spontaneous healing of acute extradural hematomas: study of twenty-two cases. Neurosurgery 1986; 18 (06) 696-700