Treatment of traumatic acute posterior fossa subdural hematoma: report of four cases with systematic review and management algorithm

Background Traumatic posterior fossa subdural hematomas (SDHs) are rare lesions. Despite improvements in intensive care and surgical management of traumatic brain injuries over the last decades, the outcome for posterior fossa subdural hematomas remains poor. Methods We conduct a retrospective study...

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Bibliographic Details
Published in:Acta neurochirurgica 2014, Vol.156 (1), p.199-206
Main Authors: de Amorim, Robson Luis Oliveira, Stiver, Shirley I., Paiva, Wellingson Silva, Bor-Seng-Shu, Edson, Sterman-Neto, Hugo, de Andrade, Almir Ferreira, Teixeira, Manoel Jacobsen
Format: Article
Language:English
Subjects:
Adult
Algorithms
Brain Injuries - complications
Brain Injuries - diagnosis
Brain Injuries - surgery
Cranial Fossa, Posterior - surgery
Female
Glasgow Coma Scale
Hematoma, Subdural, Acute - diagnosis
Hematoma, Subdural, Acute - surgery
Humans
Interventional Radiology
Medicine
Medicine & Public Health
Middle Aged
Minimally Invasive Surgery
Neurology
Neuroradiology
Neurosurgery
Retrospective Studies
Review Article - Brain Injury
Surgical Orthopedics
Treatment Outcome
Young Adult
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Summary:Background Traumatic posterior fossa subdural hematomas (SDHs) are rare lesions. Despite improvements in intensive care and surgical management of traumatic brain injuries over the last decades, the outcome for posterior fossa subdural hematomas remains poor. Methods We conduct a retrospective study over a 2-year period of patients sustaining traumatic brain injury and posterior fossa SDH. Additionally, a systematic review of case series published to date was performed. Results The incidence of posterior fossa SDH was 0,01 % (4/326). All patients in this current series had poor prognosis. Three out of four exhibited ischemic/edema lesions in postoperative CT scans leading to fourth ventricle effacement and persistent brainstem compression. Our literature review retrieved 57 patients from only seven case series. Unfavorable outcomes were seen in 63 % of patients. Conclusions Our data and data from the literature do not provide sufficient evidence to establish an optimal treatment strategy for posterior fossa SDH. However, based on lessons learned with these four cases, together with results from review of the literature, we propose an algorithm for the management of this rare condition.
ISSN:0001-6268
0942-0940
DOI:10.1007/s00701-013-1850-6