Kawakami Y, Tamiya T, Tanimoto T, Shimamura Y, Hattori S, Ueda T, Ishida T
Department of Neurological Surgery, Kobe West Municipal Hospital, Japan.
Pediatr Neurol. 1990 Mar-Apr;6(2):112-8. doi: 10.1016/0887-8994(90)90044-2.
The recommended treatment for posterior fossa epidural hematoma has been prompt surgical evacuation. We report 2 patients who were treated conservatively. Both patients were younger than 10 years of age and developed subacute symptoms and signs. Serial computed tomography demonstrated complete resolution of the hematomas and no development of hydrocephalus during nonsurgical treatment. They recovered well without any neurologic deficits. In order to evaluate an indicative factor for nonsurgical treatment in young children with posterior fossa epidural hematoma, we review both of our patients and 36 well-documented patients from the literature, all of whom were younger than 10 years of age. The results demonstrate that the development of hydrocephalus is a critical factor in clinical progression. Nonsurgical management can be applied in these circumstances until spontaneous resolution of the hematoma unless early signs of medullary compression appear acutely after head trauma or serial computed tomography demonstrates the development of hydrocephalus followed by medullary compression.
后颅窝硬膜外血肿的推荐治疗方法一直是迅速进行手术清除血肿。我们报告了2例采用保守治疗的患者。这两名患者均小于10岁，出现了亚急性症状和体征。连续的计算机断层扫描显示血肿完全消退，且在非手术治疗期间未发生脑积水。他们恢复良好，没有任何神经功能缺损。为了评估小儿后颅窝硬膜外血肿非手术治疗的指示因素，我们回顾了我们的这2例患者以及文献中36例记录完整的患者，所有这些患者均小于10岁。结果表明，脑积水的发生是临床进展的关键因素。在这些情况下，除非头部外伤后急性出现髓质受压的早期迹象，或连续计算机断层扫描显示出现脑积水并随后出现髓质受压，否则在血肿自发消退之前可采用非手术治疗。
