Journal List > Korean J Neurotrauma > v.8(2) > 1058906

Traumatic Epidural Hematoma of the Posterior Cranial Fossa

Abstract

Objective:

Epidural hematoma of posterior fossa is less common than epidural hematoma of supratentorial area, and there are not many articles about epidural hematoma of posterior fossa. This study investigated patients who underwent surgery of epidural hematoma of posterior fossa, and the relation between the clinical manifestation and postoperative outcome.

Methods:

A retrospective analysis performed of 27 patients who underwent operation for acute traumatic epidural hematoma of posterior fossa from January 2004 to December 2011. Analyzed factors were gender, age, Glasgow Coma Scale (GCS) measured upon presentation to the hospital, preoperative GCS score, cause of trauma, time elapsed from the accident to the presentation to the hospital, time elapsed from the presentation to the hospital to the surgery, radiographic findings (brain CT findings), and Glasgow Outcome Scale (GOS).

Results:

Two patients (7.4%) had GCS score on admission of 3-8, 11 (29.6%) had 9-12, and 17 (66.7%) had 13-15. In 1 (3.7%) patient, GCS score changed from 13 to 10, and preoperative GCS score was significantly correlated with GOS score (p<0.05). Mean thickness of hematoma was 19.3±7.5 mm, and was significantly correlated with GOS score (p< 0.05). GOS score was 4-5 in 24 patients (88.9%), 3 (severe disability) in 1 patient (3.7%), and 1 (death) in 2 patients (7.4%).

Conclusion:

In the patients underwent surgery for epidural hematoma of posterior fossa, 88.9% had favorable outcome (in GOS score of 4 or more). Preoperative GCS score and thickness of hematoma on brain computed tomography are important determinants of prognosis.

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TABLE 1.
Age and sex distribution of the patients
Age M (%) F (%) Total (%)
01-10 01 (3.7)0 2 (7.4)0 03 (10.7)0
11-20 03 (10.7) - 03 (10.7)0
21-30 01 (3.7)0 - 01 (3.7)0
31-40 04 (14.8) - 04 (14.8)
41-50 10 (37)0. - 10 (37)0.
51-60 04 (14.8) 1 (3.7)0 05 (17.8)
61-70 - - -
71-80 - 1 (3.7)0 01 (3.7)
Total 23 (85.2) 4 (14.8) 27 (100)
TABLE 2.
Symptom and causes of patient with posterior fossa EDH
  No. of patients (%)
Symptoms Headache 13 (48.1)
Disturbance of consciousness 13 (48.1)
Vomiting 05 (17.8)
Occipital swelling 04 (14.8)
Nausea 03 (10.7)
Diplopia 01 (3.7)
Asymptomatic Cause of injury 01 (3.7)
Traffic accidents 09 (33.3)
Fall down 07 (25.9)
Slip down 11 (40.7)
TABLE 3.
Clinical features & radiologic features of patient with posterior fossa EDH
    Favorable result (%) Unfavorable result (%) p value
Interval from accident to arrival at the hospital 16.83±38.03 h     0.463
Interval from arrival to hospital to surgery 6.56±6.76 h     0.489
Hematoma volume        
<10 cc 04 (14.8) 02 (7.4) 2 (7.4)    
>10 cc 23 (85.2) 22 (81.5) 1 (3.7)    
Hematoma thickness       0.013
<15 mm 07 (25.9) 04 (14.8) 3 (10.7)  
>15 mm 20 (74) 20 (74) 0  
Associated intracranial injury 19 (70.3) 16 (59.3) 3 (10.7) 0.226
Hemorrhagic contusion 13 (48.1) 10 (37) 3 (10.7)  
Subarachnoid hematomas 04 (14.8) 04 (14.8) 0  
Subdural hematomas 01 (3.7) 01 (3.7) 0  
Fracture 23 (85.2) 20 (74) 3 (10.7) 0.441
Linear fracture 21 (77.8) 18 (66.6) 3 (10.7)  
Diastatic fracture 02 (7.4) 02 (7.4) 0  
Supratentorial extension 19 (70.4) 18 (66.6) 1 (3.7) 0.073
Posterior fossa alone 08 (29.6) 06 (22.2) 2 (7.4) 0.131
Bilateral 05 (17.8) 04 (14.8) 1 (3.7)  
Unilateral 03 (10.7) 02 (7.4) 1 (3.7)  
TABLE 4.
The mortality and Glasgow Outcome Scale (GOS) according to admission Glasgow Coma Scale (GCS)
  GOS 5 (%) GOS 4 (%) GOS 3 (%) GOS 2 (%) GOS 1 (%) Total (%)
GCS 13-15 15 (55.6) - 1 (3.7) - 1 (3.7) 17 (66.7)
GCS 9-12 08 (29.6) - - -   08 (29.6)
GCS 3-8 - 1 (3.7) - - 1 (3.7) 02 (7.4)
Total 23 (85.2) 1 (3.7) 1 (3.7) 0 2 (7.4) 27 (100)0.
TABLE 5.
The mortality and Glasgow Outcome Scale (GOS) according to preoperative Glasgow Coma Scale (GCS)
  GOS 5 (%) GOS 4 (%) GOS 3 (%) GOS 2 (%) GOS 1 (%) Total (%)
GCS 13-15 15 (55.6) - 1 (3.7) - - 16 (63)0.
GCS 9-12 08 (29.6) - - - 1 (3.7) 09 (33.3)
GCS 3-8 - 1 (3.7) - - 1 (3.7) 02 (7.4)
Total 23 (85.2) 1 (3.7) 1 (3.7) 0 2 (7.4) 27 (100)0.
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