Bozbuğa M, Izgi N, Polat G, Gürel I
Department of Neurosurgery, Kartal Research and Teaching Hospital, Istambul, Turkey.
Neurosurg Rev. 1999;22(1):34-40. doi: 10.1007/s101430050006.
The posterior fossa is an uncommon site for epidural hematomas. Clinical progress is silent and slow, but the deterioration is sudden and quick to become fatal if not promptly treated. Early recognition is therefore extremely important. The recommended treatment for posterior fossa epidural hematoma is surgical evacuation soon after the diagnosis, since the posterior fossa contains vital structures. However, conservative management under close clinical and radiological supervision can be applied in patients without mass effect. In our study, a review of 73 cases with posterior fossa epidural hematoma among a total number of 737 patients with epidural hematoma is presented, and a new neuroradiological classification is proposed in order to determine the appropriate type of treatment. In this series, 14 patients were treated conservatively, while 59 required surgery. The conservatively treated 9 pediatric and 5 adult patients, and 51 of the 59 surgically treated cases, in other words a total of 65 of the 73 patients, showed excellent recovery; 4 patients treated surgically had a moderate disability, and 4 patients died (overall mortality 5.4%). The critical factors influencing outcome were the neuroradiological class, the level of consciousness just before the operation, and the other systemic and/or intracranial traumatic lesions. In this study, the critical observation was that the neuroradiological findings were earlier, more reliable and predictive than the clinical findings. Therefore, based upon the obliteration of perimesencephalic cisterns and/or displacement of the fourth ventricle, a new neuroradiological classification was designed for decision-making in management.
后颅窝是硬膜外血肿的少见部位。临床进展隐匿且缓慢，但如果不及时治疗，病情恶化会突然且迅速致命。因此早期识别极为重要。后颅窝硬膜外血肿的推荐治疗方法是诊断后尽快进行手术清除，因为后颅窝包含重要结构。然而，对于没有占位效应的患者，可在严密的临床和影像学监测下进行保守治疗。在我们的研究中，对737例硬膜外血肿患者中的73例后颅窝硬膜外血肿病例进行了回顾，并提出了一种新的神经放射学分类方法，以确定合适的治疗类型。在这个系列中，14例患者接受了保守治疗，而59例需要手术。保守治疗的9例儿童和5例成人患者，以及59例手术治疗病例中的51例，换句话说，73例患者中的65例恢复良好；4例手术治疗的患者有中度残疾，4例患者死亡（总死亡率5.4%）。影响预后的关键因素是神经放射学分类、术前意识水平以及其他全身和/或颅内创伤性病变。在本研究中，关键的观察结果是神经放射学表现比临床发现更早、更可靠且更具预测性。因此，基于中脑周围脑池的闭塞和/或第四脑室的移位，设计了一种新的神经放射学分类方法用于管理决策。
