Traumatic Posterior Fossa Epidural Hematomas in Children : Experience with 48 Cases and a Review of the Literature

Operative versus non-operative management of posterior fossa epidural hematoma: A systematic review and meta-analysis

BACKGROUND

Posterior fossa epidural hematoma (PFEDH) is rare, occurring in less than 3% of head injuries. It can be managed either operatively or non-operatively. Management guidelines date from 2006, without recent updates providing class III evidence.

METHOD

We searched PubMed and other databases for English language observational studies up to 2021 that compared the two treatment approaches for PFEDH and.

RESULTS

Twenty-four of the 350 references, for involving 874 patients, met the study criteria. Conservative management showed higher GOS 5 scores and lower mortality. GCS 13-15 patients were more prevalent in the conservative group. Surgical cases often involved ventriculomegaly/compression, hydrocephalus or contusion.

CONCLUSION

The study shed light on surgical versus conservative PFEDH management, although evidence is sparse. Generally, conservative methods showed better initial outcomes, and should be preferred. However, respect of individual patient traits and Brain Trauma Foundation guidelines is crucial: conservative management may not suit all cases. To enhance the evidence base, RCTs are important for optimal PFEDH management. Bridging this gap can substantially improve patient outcomes and clinical decision-making, emphasizing the need to consider both the available evidence and patient-specific factors for effective guidance.

Axial Convex-Shaped Hematoma was Associated with Poor Curative Effect of Surgical Treatment for Traumatic Posterior Fossa Epidural Hematoma in Children

BACKGROUND

Posterior fossa epidural hematoma (PFEDH) is rare which accounts for just 4-12.9% of all EDH cases. Since its frequently subtle and nonspecific clinical presentation, CT scan has great importance for early diagnosis and treatment of PFEDH. However, indications for surgery depending on the findings of CT image are still controversial.

METHODS

We retrospectively analyzed 40 pediatric cases of PFEDH. Their baseline characteristic, clinical presentation, imaging findings and outcomes were collected and analyzed. The ellipsoid volume equation X × Y × Z/2 was used to measure the hematoma volume. The Glasgow Outcome Scale (GOS) was used to assess the neurologic functional outcome.

RESULTS

A total of 40 pediatric PFEH patients were included with 8 patients having poor outcome and 32 patients having a relatively good prognosis. GCS score showed a significant difference between good and poor outcome groups (p < 0.001). Y value on CT image was significantly bigger in poor outcome group than good outcome group (p < 0.01). Similar results were got in X/Z value (p < 0.05) and Y/Z value (p < 0.01) which reflected the shape of hematoma. A predictive model with Y + X/Z showed the largest area under the ROC curve with a sensitivity of 75.0% and specificity of 93.7%.

CONCLUSIONS

GCS score at admission was closely related to the prognosis of the pediatric patients with PFEDH. The morphometry of PFEDH has a crucial role in judging the prognosis. Axial convex-shaped hematoma was associated with poor curative effect of surgical treatment.

Prognostic Factors and Outcome of Surgically Treated Supratentorial versus Infratentorial Epidural Hematoma in Pediatrics: A Comparative Study of 350 Patients at a Tertiary Center of a Developing Country

PURPOSE

In children, epidural hematomas (EDHs) constitute around 2% to 3% of all head traumas. The aim of this study is to compare the manifestation, prognostic factors, and outcome of surgically treated supratentorial with infratentorial EDHs in pediatric patients.

METHODS

This is a hospital-based single-center, retrospective study of 350 pediatric patients admitted between January 2016 and December 2021. All pediatric patients to 18 years of age with posttraumatic EDHs with or without other intracranial/extracranial injuries who underwent surgical evacuation were included in the study. Posttraumatic EDHs treated conservatively during the hospital stay and any EDH unrelated to head trauma were excluded. Glasgow Outcome Scale (GOS) score was used to assess functional outcomes at discharge. The status of the patients at 3-month follow-up was assessed by using the pediatric version of the Glasgow Outcome Scale-Extended (GOS-E Peds) Score.

RESULTS

Out of 350 patients, 310 had supratentorial EDH and 40 had infratentorial EDH. In supratentorial EDH, the volume of hematoma, mass effect, and the time interval between trauma and surgery correlated with functional outcome (GOS) at discharge. Anisocoria, hypotension, and intradural injury were associated with functional as well as behavioral outcomes (GOS-E Peds) in the supratentorial EDH group. The severity of the injury was correlated with the functional and behavioral outcomes in both groups.

CONCLUSIONS

Infratentorial EDH has better clinical outcomes than supratentorial EDH in surgically treated pediatric patients. The most significant and consistent factor influencing the outcome in both groups was the Glasgow Coma Score on admission.

The uncommon delayed neurological deficit in posterior fossa chronic epidural hematoma: A case report

BACKGROUND

Chronic epidural hematoma (CEDH) is uncommon and therefore, less well characterized. The incidence of CEDH ranges from 3.9 % to 30 % of all epidural hematomas. Posterior fossa epidural hematomas represent a rare clinical entity. It has been reported in only 4-7 % of all extradural hematomas. This rare condition may present with rapid clinical deterioration by quick increase in size that may cause brain stem compression. This study aims to provide a case of chronic epidural hematoma with uncommon sign of delayed neurological deficits, specifically in the posterior fossa region.

CASE PRESENTATION

We report a case of a 34-years-old male with left upper and lower extremities weakness for 3 days before admission. The patient had a history of falling from a height of approximately 3 m about 3 weeks ago. Craniotomy epidural hematoma evacuation was performed on the patient.

CONCLUSION

Chronic epidural hematoma is uncommon and therefore, less well characterized. The results of surgical care of symptomatic chronic posterior fossa EDH are often excellent. Early diagnosis and emergent evacuation provide better outcome.

Rapid resolution of a traumatic venous epidural hematoma in a 3-year-old child: illustrative case

BACKGROUND

Posterior fossa epidural hematoma rarely occurs in children after traumatic head injury. There is ongoing discussion about appropriate treatment, yet the radiological features regarding the time to resorption of the hematoma or required follow-up imaging are rarely discussed.

OBSERVATIONS

The authors presented the case of a 3-year-old child who was under clinical observation and receiving analgetic and antiemetic treatment in whom near-complete hematoma resorption was shown by magnetic resonance imaging as soon as 60 hours after diagnosis. The child was neurologically stable at all times and showed no deficit after observational treatment. Hematoma resorption was much faster than expected. The authors discussed hematoma drainage via the sigmoid sinus.

LESSONS

Epidural hematomas in children can be treated conservatively and are resorbed in a timely manner.

Management of traumatic posterior fossa epidural hematomas in pediatrics: our experience and review of the literature

BACKGROUND AND AIMS

Conservative management of posterior fossa epidural hematoma in the pediatric age group has been increasingly considered in the last decade with good clinical outcomes and comparable results to surgical intervention in carefully selected patients. The purpose of this study is to evaluate the outcome of observation in the management of pediatric patients with posterior fossa epidural hematoma (PFEDH) in our tertiary hospital and present a literature review on PFEDH pediatric patients.

METHODS

We conducted a retrospective observational study at King Abdullah University Hospital (KAUH), a tertiary hospital in North Jordan. All pediatric patients (≤ 18 years) who were admitted with a diagnosis of PFEDH from January 2010 to December 2020 were included. Demographic data, trauma type, clinical signs and symptoms on admission, CT findings, treatment type, and outcomes were collected and assessed. The outcome was measured using the Glasgow outcome scale (GOS) on discharge from the hospital.

RESULTS

A total of 16 patients were identified and included in this study. Nine patients were managed conservatively and 7 surgically. The mean age was 7.7 ± 6 years ranging from 1 to 18 years. Falls were the most common cause of injury. Vomiting was the most frequent presenting symptom. Except for 1 patient, 14 patients had good outcomes with a GOS of 5. One case of mortality was seen in our series.

CONCLUSION

Posterior fossa epidural hematoma is a rare clinical condition among the pediatric age group. Early and consecutive CT scans must be obtained for all suspected cases. Successful conservative management can be achieved depending on multiple factors such as hematoma thickness or volume, neurological status on admission, and other radiological findings as shown in our study. The overall prognosis was good in our patients.

Clinical guidelines for traumatic brain injuries in children and boys

The main aim of management of pediatric traumatic brain injury (TBI) is to hold normal ranges for optimizing the most proper outcomes. However, to provide physiologic requirements to an injured brain it is very important to enhance the quality of recovery and minimize secondary injuries. The aim of study is to identify proper guidelines to manage pediatric TBI. A comprehensive research was conducted on biomedical and pharmacologic bibliographic databases of life sciences, i.e., PubMed, EMBASE, MEDLINE, LILACS database, global independent network of Cochrane, Science Direct and global health library of Global Index Medicus (GIM) from 2000 to 2019. Main objective of this study was to provide a comprehensive review of available clinical practice guidelines for TBI. These guidelines can be administered to a pediatric population to improve the quality of clinical practice for TBI. These guidelines could be applied worldwide, despite different traditional demographic and geographic boundaries, which could affect pediatric populations in various ranges of ages. Accordingly, advances in civil foundations and reforms of health policies may decrease pediatric TBI socioeconomic burdens.