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Khormi YH, Aly MM, Hamda HK, Yousef AA, Hanbashi AI, Atteya MME. Pediatric retroclival hematomas. Childs Nerv Syst 2024; 40:1389-1404. [PMID: 38010432 DOI: 10.1007/s00381-023-06233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Traumatic retroclival hematomas (RCHs) are infrequent occurrences among the pediatric population. The existing body of research pertaining to these hematomas primarily consists of case reports or small case series, which do not provide adequate guidance for managing this condition. OBJECTIVE This study aims to present a report on four cases of RCHs. Additionally, we aim to conduct a systematic review to consolidate the existing literature on pediatric RCHs. METHODS The authors conducted a systematic review in accordance with the PRISMA and CARE guidelines. A multivariate logistic regression model was developed to evaluate the potential impact of various clinical variables on clinical outcomes. The study also documented four of our cases, one of which was a rare occurrence of spontaneous subdural RCH. RESULTS A total of 62 traumatic RCHs have been documented in the literature. We documented three cases of traumatic RCHs and one case of spontaneous RCH. A systematic analysis of 65 traumatic RCHs was performed. Of trauma cases, 64.6% demonstrated craniocervical junction instability with 83.3% ligamentous involvement. Thirty-five patients were males. 50.7% were aged between 5 and 9 years. Cranial nerve palsies occurred in 29 patients (27 had abducent palsy), 26 of which resolved within 6 months of trauma. 23.5% underwent surgery, and 76.5% were conservatively managed. Surgeries targeted hematomas, hydrocephalus, or craniocervical instability. Approaches to hematomas included transclival and far/extreme lateral suboccipital approaches. Clinical outcome was good in 75.4% and intermediate or poor in 24.6%. Logistic regression suggested an association between craniocervical junction injuries and poor or intermediate outcomes (OR 4.88, 95% CI (1.17, 27.19), p = 0.04). CONCLUSION Pediatric RCHs are mostly traumatic and extradural. Children between 5 and 9 years old are most vulnerable. Craniocervical junction injuries, mainly ligamentous, are common in RCHs and are associated with intermediate or poor outcomes. Cervical MRI could be important in cases of trauma to rule out ligamentous injuries of the craniocervical junction. The small size of RCHs should not exempt the careful assessment of craniocervical junction instability. Cranial nerve palsies are common and usually resolve within 6 months. Conservative treatment is typical unless brainstem compression, hydrocephalus, or craniocervical junction instability exists.
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Affiliation(s)
- Yahya H Khormi
- Department of Surgery, Neurosurgery Division, Jazan University, Al Maarifah Road, PO Box 114, 45142, Jazan, Saudi Arabia.
- Department of Neurosurgery, King Fahd Central Hospital, Jazan, Saudi Arabia.
| | - Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt
| | - Hossam K Hamda
- Department of Radiology, Emergency Division, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Aly Abdelrahman Yousef
- Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Helwan University, Cairo, Egypt
| | | | - Mostafa M E Atteya
- Department of Neurosurgery, King Fahd Central Hospital, Jazan, Saudi Arabia
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Khormi YH. Retroclival hematomas in adult patients: A systematic review of a rare intracranial hematoma. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Perciaccante A, Cucu AI. Possible Post-traumatic Abducens Nerve Palsy in a 16th Century Fresco ("the Chamber of the Giants" by Giulio Romano). J Neuroophthalmol 2021; 41:e401-e402. [PMID: 34415284 DOI: 10.1097/wno.0000000000001368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Antonio Perciaccante
- Department of Medicine (AP), Azienda Sanitaria Universitaria Giuliano Isontina, "San Giovanni di Dio" Hospital, Gorizia, Italy ; Laboratoire Anthropologie Archéologie Biologie (LAAB) (AP), Université Paris-Saclay, UFR des Sciences de La Santé, Montigny-le-Bretonneux, France; and Department of Neurosurgery (AIC), N. Oblu Clinical Emergency Hospital, Iasi, Romania
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Caglar YS, Erdogan K, Kilinc CM, Mammadkhanli O, Ozgural O, Eroglu U. Retroclival epidural hematoma: A rare location of epidural hematoma, case report, and review of literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:342-346. [PMID: 33824566 PMCID: PMC8019111 DOI: 10.4103/jcvjs.jcvjs_97_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
Retroclival epidural hematoma in adults is uncommon. Although most cases are associated with craniocervical trauma, other mechanisms have been reported, such as coagulopathy, vascular lesions, and pituitary apoplexy. We report two adults diagnosed with retroclival epidural hematoma. One patient was an 89-year-old male with leukemia and thrombocytopenia who sustained a fall and developed a traumatic retroclival epidural hematoma with brainstem compression; surgery could not be performed due to his clinical condition and he died 5 days later. The other patient was a 78-year-old female with atrial fibrillation who developed a spontaneous retroclival epidural hematoma as a result of warfarin use; she was treated conservatively with anticoagulant reversal and methylprednisolone and was subsequently discharged without neurological deficit. Retroclival hematomas are primarily treated conservatively due to the difficulty of surgical approach. The bleeding mechanism and dural and venous anatomy of this region tend to limit hematoma expansion.
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Affiliation(s)
- Yusuf Sukru Caglar
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | - Koral Erdogan
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | - Cemil Mustafa Kilinc
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | | | - Onur Ozgural
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
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Abstract
Retroclival epidural hematomas are particularly rare conditions that are frequently the result of high-energy, hyperflexion-hyperextension injuries in pediatric patients. We present the case of a 7-year-old previously healthy girl with traumatic retroclival epidural hematoma after a fall from a swing. She presented with a Glasgow Coma Scale score of 15 with severe neck pain and limitation of cervical movements in all directions. Radiological examination revealed retroclival epidural hematoma, and the patient was managed conservatively with good recovery. Although conservative management leads to good recovery in most cases, retroclival epidural hematomas should always be kept in mind regardless of the severity of trauma.
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Affiliation(s)
- Yavuz Samanci
- From the Neurosurgery Clinic, Istanbul Training and Research Hospital
| | | | - Suat Erol Celik
- Neurosurgery Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Solorio-Pineda S, Nieves-Valerdi AA, Franco-Jiménez JA, Gutiérrez-Aceves GA, Buenrostro-Torres LM, Ruíz-Flores MI. Retroclival and spinal subdural hematoma after traumatic brain injury - A case report and literature review. Surg Neurol Int 2019; 10:86. [PMID: 31528424 PMCID: PMC6744770 DOI: 10.25259/sni-11-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/07/2019] [Indexed: 11/04/2022] Open
Abstract
Background Retroclival hematomas are rare and occur mostly in the pediatric population. They are variously attributed to trauma, apoplexy, and vascular lesions. With motor vehicle accidents (MVAs), the mechanism of traumatic injury is forced flexion and extension. There may also be associated cervical spinal and/or clivus fractures warranting fusion. Case Description A 35-year-old male sustained a traumatic brain injury after a fall of 5 m at work. His Glasgow coma scale (GCS) on admission was 13 (M6V3O4). He had no cranial nerve deficits. The brain computed tomography (CT) showed a retroclival subdural hematoma that extended to the C2 level. Conclusions Most retroclival hematomas are attributed to MVAs, and cranial CT and magnetic resonance studies typically demonstrate a combination of posterior fossa hemorrhage with retroclival hematomas (intra or extradural). Patients with retroclival hematomas but high GCS scores on admission usually have better prognoses following traumatic brain injuries attributed to MVA. Notable however is the frequent association with additional cervical and/or craniocervical injuries (e.g. such as odontoid fracture) that may warrant surgery/fusión.
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Affiliation(s)
- Saúl Solorio-Pineda
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México
| | - Adriana Ailed Nieves-Valerdi
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México
| | - José Alfonso Franco-Jiménez
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México
| | - Guillermo Axayacalt Gutiérrez-Aceves
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México.,Radioneurosurgery Unit, Neurological Center, Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Dr. Manuel Velasco Suarez", Av. Insurgentes Sur No. 3877, La Fama, México.,American British Cowray Medical Center, Carlos Graef Fernández No. 154, Col. Santa Fe, Cuajimalpa, México City, México
| | - Luis Manuel Buenrostro-Torres
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México
| | - Milton Inocencio Ruíz-Flores
- Department of Neurosurgery, Centro Médico "Lic. Adolfo López Mateos", ISEM. Av Nicolás San Juan S/N, Colonia ex-Hacienda la Magdalena, Toluca, Estado de México, México
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Ravindran K, Lorensini B, Gaillard F, Kalus S. Bilateral traumatic abducens nerve avulsion: A case series and literature review. J Clin Neurosci 2017; 44:30-33. [PMID: 28673673 DOI: 10.1016/j.jocn.2017.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/12/2017] [Indexed: 11/26/2022]
Abstract
Although abducens nerve palsy is an established sequela of head trauma - given the prolonged intracranial course of the nerve - bilateral injury is rare. Here, we present two cases of bilateral traumatic abducens nerve avulsion, in the absence of regional fractures, one of which presented two months following the initial trauma. Additionally, we review the current literature on bilateral abducens nerve palsy secondary to trauma, discussing the anatomy of the nerve's course and potential mechanisms of injury.
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Affiliation(s)
- Krishnan Ravindran
- Department of Radiology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Bruno Lorensini
- Department of Radiology, Ultramed SRA Group, Londrina, PR, Brazil
| | - Frank Gaillard
- Department of Radiology, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Radiology, The University of Melbourne, Parkville, VIC, Australia
| | - Sarah Kalus
- Department of Radiology, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Radiology, The University of Melbourne, Parkville, VIC, Australia
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Silvera VM, Danehy AR, Newton AW, Stamoulis C, Carducci C, Grant PE, Wilson CR, Kleinman PK. Retroclival collections associated with abusive head trauma in children. Pediatr Radiol 2014; 44 Suppl 4:S621-31. [PMID: 25501734 DOI: 10.1007/s00247-014-3170-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/07/2014] [Accepted: 08/20/2014] [Indexed: 11/29/2022]
Abstract
Retroclival collections are rare lesions reported almost exclusively in children and strongly associated with trauma. We examine the incidence and imaging characteristics of retroclival collections in young children with abusive head trauma. We conducted a database search to identify children with abusive head trauma ≤ 3 years of age with brain imaging performed between 2007 and 2013. Clinical data and brain images of 65 children were analyzed. Retroclival collections were identified in 21 of 65 (32%) children. Ten (48%) were subdural, 3 (14%) epidural, 2 (10%) both, and 6 (28%) indeterminate. Only 8 of 21 retroclival collections were identifiable on CT and most were low or intermediate in attenuation. Eighteen of 21 retroclival collections were identifiable on MRI: 3 followed cerebral spinal fluid in signal intensity and 15 were bloody/proteinaceous. Additionally, 2 retroclival collections demonstrated a fluid-fluid level and 2 enhanced in the 5 children who received contrast material. Sagittal T1-weighted images, sagittal fluid-sensitive sequences, and axial FLAIR (fluid-attenuated inversion recovery) images showed the retroclival collections best. Retroclival collections were significantly correlated with supratentorial and posterior fossa subdural hematomas and were not statistically correlated with skull fracture or parenchymal brain injury. Retroclival collections, previously considered rare lesions strongly associated with accidental injury, were commonly identified in this cohort of children with abusive head trauma, suggesting that retroclival collections are an important component of the imaging spectrum in abusive head trauma. Retroclival collections were better demonstrated on MRI than CT, were commonly identified in conjunction with intracranial subdural hematomas, and were not significantly correlated with the severity of brain injury or with skull fractures.
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Affiliation(s)
- V Michelle Silvera
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, 02115, Boston, MA, USA,
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Dengler BA, Bartanusz V. Bilateral abducens nerve palsy following ligamentous C1-C2 distraction. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23 Suppl 2:248-52. [PMID: 24311020 DOI: 10.1007/s00586-013-3121-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/24/2013] [Accepted: 11/24/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Posttraumatic abducens nerve palsy is well documented following head injury, but only few case reports exist on sixth nerve palsy after cervical spine trauma. Bilateral abducens palsy following vertical C1-C2 ligamentous distraction has not been described yet. METHODS We report two patients who sustained motor vehicle accident-related C1-C2 distraction injury and were diagnosed with posttraumatic bilateral abducens nerve palsy. RESULTS Patients underwent surgical stabilization of the upper cervical spine and demonstrated a remarkable recovery of the sixth nerve deficit up to 1 year after injury. CONCLUSION We hypothesize that ligamentous C1-C2 distraction leads to caudal displacement of the brainstem in relation to the cranial base causing traction injury to the abducens nerve at its entry into Dorello's canal in the cavernous sinus.
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Affiliation(s)
- Bradley A Dengler
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA
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Smith KM, Yoganandan N, Pintar FA, Kurpad SN, Maiman DJ. Atlantooccipital dislocation in motor vehicle side impact, derivation of the mechanism of injury, and implications for early diagnosis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2011; 1:113-7. [PMID: 21572632 PMCID: PMC3075827 DOI: 10.4103/0974-8237.77675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Numerous reports of atlantooccipital dislocations (AODs) have been described in frontal impacts and vehicle versus pedestrian collisions. Reports of survival after AOD in conjunction with side impacts have infrequently been reported in the literature. The objective of this study is to present a case of an AOD from a side impact vehicle collision, and deduce the mechanism of injury. A clinical and biomechanical reconstruction of the collision was performed to investigate the mechanism of the dislocation. A 51-year-old female was traveling in a four-door sedan and sustained a side impact collision with a compact pickup truck. At the time of extrication, the patient was neurologically intact with a Glasgow Coma Scale score of 15. After admittance to the hospital, the patient developed a decline in respiratory status, right mild hemiparesis, and left sixth-nerve palsy, and magnetic resonance imaging (MRI) and computed tomography (CT) reconstructions indicated a craniocervical dislocation. Surgical fixation was performed and all extra-axial hemorrhaging was evacuated. At discharge, the patient was neurologically intact on the left side, had right mild hemiparesis, left sixth-nerve palsy, and minor dysarthria. Survival rates of AODs have recently been increasing. Morbidity is still more prevalent, however. Due to the variety of symptoms that accompany AODs and the inconsistency of diagnostic imaging techniques, a thorough history of the etiology may lead to increased clinical suspicion of this injury and further raise survival rates.
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Affiliation(s)
- Kevin M Smith
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Topcu-Yilmaz P, Repka MX. Abducens nerve palsy associated with a clival epidural hematoma. J AAPOS 2011; 15:69-70. [PMID: 21315630 DOI: 10.1016/j.jaapos.2010.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/21/2010] [Accepted: 10/26/2010] [Indexed: 11/26/2022]
Abstract
A clival epidural hematoma is a rare lesion that usually develops after a hyperflexion or hyperextension injury of the neck, often in a child. A 5-year-old girl presented after a motor vehicle accident with multiple cranial neuropathies, including bilateral abducens nerve pareses and right facial, glossopharyngeal, and hypoglossal cranial nerve palsies. Neuroimaging identified a clival epidural hematoma. The child was observed and the hematoma resolved. The abducens nerve palsies resolved during the ensuing 14 months.
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Affiliation(s)
- Pinar Topcu-Yilmaz
- Zanvyl Krieger Children's Eye Center, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287-9028, USA
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