Verma Satish Kumar, Borkar Sachin Anil, Singh Pankaj Kumar, Tandon Vivek, Gurjar Hitesh Kumar, Sinha Sumit, Satyarthee Guru Dutta, Gupta Deepak, Agarwal Deepak, Sharma Bhawani Shankar
Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
Asian J Neurosurg. 2018 Apr-Jun;13(2):227-232. doi: 10.4103/1793-5482.228536.
Posterior fossa extradural hematoma (PFEDH) is rare among the traumatic brain injury and represent about 4-7% cases of all EDHs. This rare condition is rapidly fatal unless identified and intervened timely. Because of limited space in posterior fossa, comparatively small volume can cause clinical deterioration. Early diagnosis by cranial computed tomography and emergent evacuation is vital for a good outcome.
This study was conducted at Level I trauma center at All India Institute of Medical Sciences, New Delhi, India. Hospital medical records were reviewed from September 2007 to June 2015. There were 856 cases of acute EDHs and of these 69 cases had PFEDHs. Records of patients with PFEDHs were reviewed for the mode of injury, Glasgow Coma Scale (GCS) at admission, imaging, type of intervention, outcome, and follow-up. GCS was assessed at 6 months and 12 months follow-up. Pertinent literature is reviewed.
Of these 69 patients, 51 were males and 18 females. The mean age of patients was 28.6 years (range 4-43 years). Forty-three patients had GCS 15 at admission, and only 4 of them had admission GCS <8. Mean EDH volume was 29.2 ml. Sixty-six patients were operated, three managed conservatively. Sixty-seven patients were discharged, of which, 56 (81.1%) had GCS 15. Two patients died. Most common associated injuries were long bone fractures (18, 26.1%) followed by blunt injury thorax (11, 15.9%). Mean follow-up duration was 69.2 months (range 6-94 months). At 6 months follow-up, 61 (88.4%) patients had good recovery (Glasgow Outcome Score [GOS] 5) and at 12 months, 62 (89.8%) had GOS 5.
PFEDH are rare. They are usually associated with occipital bone fractures and may also have a supratentorial hematoma. It may be rapidly fatal due to the expansion of hematoma and compromise of the posterior cranial fossa space leading to brainstem compression, tonsillar herniation, and/or obstructive hydrocephalus. Early diagnosis and emergent evacuation lead to good outcome.
后颅窝硬膜外血肿（PFEDH）在创伤性脑损伤中较为罕见，约占所有硬膜外血肿病例的4 - 7%。这种罕见情况若不及时识别和干预，会迅速致命。由于后颅窝空间有限，相对较小的血肿量也可导致临床病情恶化。通过头颅计算机断层扫描早期诊断并紧急清除血肿对于取得良好预后至关重要。
本研究在印度新德里全印度医学科学研究所的一级创伤中心进行。回顾了2007年9月至2015年6月的医院病历。共有856例急性硬膜外血肿病例，其中69例为后颅窝硬膜外血肿。对后颅窝硬膜外血肿患者的病历进行回顾，内容包括受伤方式、入院时的格拉斯哥昏迷量表（GCS）评分、影像学检查、干预类型、预后及随访情况。在6个月和12个月随访时评估GCS评分。并查阅了相关文献。
这69例患者中，男性51例，女性18例。患者平均年龄为28.6岁（范围4 - 43岁）。43例患者入院时GCS评分为15分，其中只有4例入院时GCS评分<8分。硬膜外血肿平均体积为29.2毫升。66例患者接受了手术，3例保守治疗。67例患者出院，其中56例（81.1%）GCS评分为15分。2例患者死亡。最常见的合并伤是长骨骨折（18例，26.1%），其次是钝性胸部损伤（11例，15.9%）。平均随访时间为69.2个月（范围6 - 94个月）。在6个月随访时，61例（88.4%）患者恢复良好（格拉斯哥预后评分[GOS]为5分），在12个月时，62例（89.8%）患者GOS为5分。
后颅窝硬膜外血肿较为罕见。它们通常与枕骨骨折相关，也可能伴有幕上血肿。由于血肿扩大及后颅窝空间受压导致脑干受压、小脑扁桃体疝和/或梗阻性脑积水，可能会迅速致命。早期诊断和紧急清除血肿可带来良好预后。
