Khormi Yahya H, Aly Mohamed M, Hamda Hossam K, Yousef Aly Abdelrahman, Hanbashi Adel Ibrahim, Atteya Mostafa M E
Department of Surgery, Neurosurgery Division, Jazan University, Al Maarifah Road, PO Box 114, 45142, Jazan, Saudi Arabia.
Department of Neurosurgery, King Fahd Central Hospital, Jazan, Saudi Arabia.
Childs Nerv Syst. 2024 May;40(5):1389-1404. doi: 10.1007/s00381-023-06233-3. Epub 2023 Nov 27.
Traumatic retroclival hematomas (RCHs) are infrequent occurrences among the pediatric population. The existing body of research pertaining to these hematomas primarily consists of case reports or small case series, which do not provide adequate guidance for managing this condition.
This study aims to present a report on four cases of RCHs. Additionally, we aim to conduct a systematic review to consolidate the existing literature on pediatric RCHs.
The authors conducted a systematic review in accordance with the PRISMA and CARE guidelines. A multivariate logistic regression model was developed to evaluate the potential impact of various clinical variables on clinical outcomes. The study also documented four of our cases, one of which was a rare occurrence of spontaneous subdural RCH.
A total of 62 traumatic RCHs have been documented in the literature. We documented three cases of traumatic RCHs and one case of spontaneous RCH. A systematic analysis of 65 traumatic RCHs was performed. Of trauma cases, 64.6% demonstrated craniocervical junction instability with 83.3% ligamentous involvement. Thirty-five patients were males. 50.7% were aged between 5 and 9 years. Cranial nerve palsies occurred in 29 patients (27 had abducent palsy), 26 of which resolved within 6 months of trauma. 23.5% underwent surgery, and 76.5% were conservatively managed. Surgeries targeted hematomas, hydrocephalus, or craniocervical instability. Approaches to hematomas included transclival and far/extreme lateral suboccipital approaches. Clinical outcome was good in 75.4% and intermediate or poor in 24.6%. Logistic regression suggested an association between craniocervical junction injuries and poor or intermediate outcomes (OR 4.88, 95% CI (1.17, 27.19), p = 0.04).
Pediatric RCHs are mostly traumatic and extradural. Children between 5 and 9 years old are most vulnerable. Craniocervical junction injuries, mainly ligamentous, are common in RCHs and are associated with intermediate or poor outcomes. Cervical MRI could be important in cases of trauma to rule out ligamentous injuries of the craniocervical junction. The small size of RCHs should not exempt the careful assessment of craniocervical junction instability. Cranial nerve palsies are common and usually resolve within 6 months. Conservative treatment is typical unless brainstem compression, hydrocephalus, or craniocervical junction instability exists.
创伤性斜坡后血肿（RCHs）在儿科人群中并不常见。有关这些血肿的现有研究主要由病例报告或小型病例系列组成，并未为这种病症的管理提供充分指导。
本研究旨在报告4例RCHs病例。此外，我们旨在进行系统综述，以整合有关小儿RCHs的现有文献。
作者根据PRISMA和CARE指南进行了系统综述。开发了多变量逻辑回归模型，以评估各种临床变量对临床结果的潜在影响。该研究还记录了我们的4例病例，其中1例为罕见的自发性硬膜下RCH。
文献中总共记录了62例创伤性RCHs。我们记录了3例创伤性RCHs和1例自发性RCH。对65例创伤性RCHs进行了系统分析。在创伤病例中，64.6%表现为颅颈交界区不稳定，其中83.3%涉及韧带。35例患者为男性。50.7%的患者年龄在5至9岁之间。29例患者出现颅神经麻痹（27例为展神经麻痹），其中26例在创伤后6个月内恢复。23.5%的患者接受了手术，76.5%接受了保守治疗。手术针对血肿、脑积水或颅颈不稳定。血肿的手术入路包括经斜坡和远外侧/极外侧枕下入路。75.4%的患者临床结局良好，24.6%的患者结局中等或较差。逻辑回归表明颅颈交界区损伤与不良或中等结局之间存在关联（OR 4.88，95%CI（1.17，27.19），p = 0.04）。
小儿RCHs大多为创伤性且为硬膜外血肿。5至9岁的儿童最易患病。颅颈交界区损伤，主要是韧带损伤，在RCHs中很常见，且与中等或不良结局相关。对于创伤病例，颈椎MRI对于排除颅颈交界区韧带损伤可能很重要。RCHs体积小不应免除对颅颈交界区不稳定的仔细评估。颅神经麻痹很常见，通常在6个月内恢复。除非存在脑干受压、脑积水或颅颈交界区不稳定，否则通常采用保守治疗。
