Introduction: Traumatic posterior fossa extradural hematomas (PFEDH) are rare lesions constituting <10% of all extradural hematomas. Reliance on clinical findings alone is not recommended as these are nonspecific; for all suspicious cases, it is advisable to conduct a CT scan. Only a handful of pediatric studies have been reported analyzing the outcome of such lesions. The aim of our study was to analyze outcomes for children with PFEDH managed at our apex trauma center. Materials and Methods: We conducted a retrospective analysis of pediatric patients (≤18 years) admitted with a diagnosis of traumatic PFEDH from January 2008 to February 2014. Results: Of 22 patients, 16 were managed surgically (group 1) and 6 conservatively (group 2); 1 failed conservative treatment (due to an increased EDH volume). Mean age was 11.7 years (range 2-18 years). Falls were the most common cause of injury. Vomiting and loss of consciousness were the most frequent presenting features. There were 18 mild, 2 moderate and 2 severe head injuries. The mean volume of EDH was 37.1 ml (range 18-100 ml) and 10.3 ml (8-16 ml) in the operative and conservative subgroups, respectively. Occipital bone fracture was seen in 16 cases with supratentorial extension in 11. Four complications were noted in 3 cases. Mean follow-up duration was 25.1 months (range 3-34 months). Except for 1 patient, all had excellent outcomes. There was no mortality. Conclusions: Traumatic pediatric PFEDHs are rare. Both the clinical status of the patient and the volume of the hematoma need to be assessed before deciding on surgery. Most cases have associated occipital bone fractures and around half have supratentorial extension; these need to be carefully assessed preoperatively. Torrential venous bleeding can be a major problem due to rupture of the adjacent sinuses. Timely intervention is crucial for achieving good outcome, keeping in view a low threshold for surgical evacuation. Although not innovative, this second-largest case series provides additional data and contributes to the existing literature on such lesions in pediatric patients.

Keywords:
Posterior fossa, Extradural hematoma, Glasgow Outcome Scale-Extended
1.
Gupta PK, Mahapatra AK, Lad SD: Posterior fossa extradural hematoma. Indian J Pediatr 2002;69:489-494.
2.
Sencer A, Aras Y, Akcakaya MO, Goker B, Kiris T, Canbolat AT: Posterior fossa epidural hematomas in children: clinical experience with 40 cases. J Neurosurg Pediatr 2012;9:139-143.
3.
Berker M, Cataltepe O, Ozcan OE: Traumatic epidural haematoma of the posterior fossa in childhood: 16 new cases and a review of the literature. Br J Neurosurg 2003;17:226-229.
4.
Bor-Seng-Shu E, Aguiar PH, de Almeida Leme RJ, Mandel M, Andrade AF, Marino R Jr: Epidural hematomas of the posterior cranial fossa. Neurosurg Focus 2004;16:ECP1.
5.
Bozbuga M, Izgi N, Polat G, Gürel I: Posterior fossa epidural hematomas: observations on a series of 73 cases. Neurosurg Rev 1999;22:34-40.
6.
Ammirati M, Tomita T: Posterior fossa epidural hematoma during childhood. Neurosurgery 1984;14:541-544.
7.
Ersahin Y, Mutluer S: Posterior fossa extradural hematomas in children. Pediatr Neurosurg 1993;19:31-33.
8.
Mori K, Handa H, Munemitsu H, Oda Y, Hashimoto N, Kojima M: Epidural hematomas of the posterior fossa in children. Childs Brain 1983;10:130-140.
9.
Ciurea AV, Nuteanu L, Simionescu N, Georgescu S: Posterior fossa extradural hematomas in children: report of nine cases. Childs Nerv Syst 1993;9:224-228.
10.
Costa Clara JM, Claramunt E, Ley L, Lafuente J: Traumatic extradural hematomas of the posterior fossa in children. Childs Nerv Syst 1996;12:145-148.
11.
Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J: The ABCs of measuring intracerebral hemorrhagic volumes. Stroke 1996;27:1304-1305.
12.
Jennett B, Snoek J, Bond MR, Brooks N: Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 1981;44:285-293.
13.
Hayashi T, Kameyama M, Imaizumi S, Kamii H, Onuma T: Acute epidural hematoma of the posterior fossa - cases of acute clinical deterioration. Am J Emerg Med 2007;25:989-995.
14.
Su TM, Lee TH, Lee TC, Cheng CH, Lu CH: Acute clinical deterioration of posterior fossa epidural hematoma: clinical features, risk factors and outcome. Chang Gung Med J 2012;35:271-280.
15.
Hooper RS: Extradural hemorrhages of the posterior fossa. Br J Surg 1954;42:19-26.
16.
Neubauer UJ: Extradural hematoma of the posterior fossa. Twelve years' experience with CT scan. Acta Neurochirur (Wien) 1987;87:105-111.
17.
Harwood-Nash DC, Hendrick FB, Hudson AR: The significance of skull fractures in children. Radiology 1971;101:151-155.
18.
Malik NK, Makhdoomi R, Indira B, Shankar S, Sastry K: Posterior fossa extradural hematoma: our experience and review of the literature. Surg Neurol 2007;68:155-158.
19.
Wang EC, Lim AY, Yeo TT: Traumatic posterior fossa extradural hematomas (PFEDH). Singapore Med J 1998;39:107-111.
20.
Suyama Y, Kajikawa H, Yamamura K, Sumioka S, Kajikawa M: Acute epidural hematoma of posterior fossa comparative analysis between 20 cases in adults and 10 cases in children. No Shinkei Geka 1996;24:621-624.
21.
Pang D, Horton JA, Herron JM, Wilberger JE, Vries JK: Nonsurgical management of extradural hematoma in children. J Neurosurg 1983;59:958-971.
22.
Pozzati E, Tognetti F, Cavallo M, Acciarri N: Extradural hematomas of the posterior cranial fossa. Observations on a series of 32 consecutive cases treated after the introduction of computed tomography scanning. Surg Neurol 1989;32:300-303.
23.
Otsuka S, Nakatsu S, Matsumoto S, Sato S, Motozaki T, Ban S, et al: Study on cases with posterior fossa epidural hematoma-clinical features and indications for operation. Neurol Med Chir (Tokyo) 1990;30:24-28.
24.
Wong CW: The CT criteria for conservative treatment - but under close clinical observation - of posterior fossa epidural haematomas. Acta Neurochir 1994;126:124-127.
25.
Knuckey NW, Gelbard S, Epstein MR: The management of ‘asymptomatic' epidural hematomas. A prospective study. J Neurosurg 1989;70:392-396.
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2015
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