Assessment of Modes of Injury and Outcome in Patients with Traumatic Posterior Fossa Extradural Hematomas: A Study of a Tertiary Care Hospital

  • Aurangzeb Kalhoro neurospinal cancer care institute karachi
  • Abdul Samad Panezai sandeman provincial hospital, Quetta
  • Sher Hassan
  • Lal Rehman jpmc , karachi
  • Farrukh Javed fellow , jpmc , karachi
Keywords: Glasgow Coma Scale, Extradural Hematoma, Posterior Cranial Fossa

Abstract

Objective:  The aim of study to assess the prevalence of divergent modes of injuries in traumatic posterior fossa extradural hematomas (PFEDH) along with the description of surgical and clinical management.

Material and Methods:  A descriptive study was performed at the Jinnah Postgraduate Medical Centre (JPMC), Karachi from May 2014 to October 2020. Total 37 patients who presented with posterior hematoma of any age and gender were included. CT scan Brain plain with the bone window was performed for a basic diagnosis to assess the volume, and any associated fracture, or any injury in the posterior fossa. The outcome was calculated from the scores of the Glasgow Coma Scale (GCS).

Results:  70% were male and around 30% were female patients. The mean calculated age was 32 ± 5.33 years. A road traffic trauma was the major cause of brain injury in 25 (67.56%) cases. The majority (56.75%) of patients reported headache, nausea and vomiting. 35% of patients were conservatively managed, with an average hematoma size of 3 cm on CT scan and GCS > 12 while 64.86% patients were operated, with the average size of hematoma > 3 cm and GCS < 10 while 61% of the patient had an occipital fracture. The majority of patients (8.1%) reported complications such as brain contusions and post-traumatic hydrocephalus.

Conclusion:  Post fossa EDH should be managed aggressively, especially those with low GCS (< 8), and volume > 3 cm. Patients who are to be managed conservatively also require close observation.

 

Author Biographies

Abdul Samad Panezai, sandeman provincial hospital, Quetta

SENIOR REGISTRAR,

MBBS, FCPS NEUROSURGERY

Sher Hassan

SENIOR REGISTRAR

MBBS FCPS NEUROSUGERY

 

Lal Rehman, jpmc , karachi

PROFESSOR NEUROSURGERY

Farrukh Javed, fellow , jpmc , karachi

FELLOW NEUROSUGERY

References

REFERENCES:
1. Parashar VS, Kankane VK, Jaiswal G, Gupta TK. Traumatic posterior fossa extradural hematoma: A comprehensive analysis of cases from a tertiary care centre in Southwestern Rajasthan. Romanian Neurosurgery. 2019;15:160-5.
2. Bhardwaj S, Sharma V, Sharma S, Purohit D, Chopra S. Traumatic Posterior Fossa Hematoma, A Rare Entity: Study of 21 Cases. Journal of neurosciences in rural practice. 2019;10(4):675.
3. Muhammed GT, Aboud SH. Patterns and outcomes of posterior fossa extradural hematoma-six years study in emergency hospitals of Erbil city. Journal of Kurdistan Board of Medical Specialties. 2019;5(2):36-41.
4. Verma SK, Borkar SA, Singh PK, Tandon V, Gurjar HK, Sinha S, Satyarthee GD, Gupta D, Agarwal D, Sharma BS. Traumatic posterior fossa extradural hematoma: Experience at level I trauma center. Asian journal of neurosurgery. 2018;13(2):227.
5. Moussa AA, Mahmoud ME, Yousef HA. Conservative management of significant epidural haematomas. Egyptian Journal of Neurosurgery. 2018;33(1):1-3.
6. Kang SH, Chung YG, Lee HK. Rapid Disappearance of Acute Posterior Fossa Epidural Hematoma—Case Report—. Neurologia medico-chirurgica. 2005;45(9):462-3.
7. Aji YK, Apriawan T, Bajamal AH. Traumatic supra-and infra-tentorial extradural hematoma: case series and literature review. Asian journal of neurosurgery. 2018;13(2):453.
8. Haq NU, Azam F, Ishfaq M, Khan BZ, Jalal A. Clinical presentation and outcome of traumatic epidural hematomas in posterior fossa: study of 34 cases. Journal of Postgraduate Medical Institute (Peshawar-Pakistan). 2016;30(3).
9. Chaoguo Y, Xiu L, Liuxun H, Hansong S, Nu Z. Traumatic posterior fossa epidural hematomas in children: experience with 48 cases and a review of the literature. Journal of Korean Neurosurgical Society. 2019;62(2):225.
10. Kumar JS, Kumar GT, Gaurav J, Kumar LV, Patel P. Traumatic isolated intracerebellar haematoma without any supratentorial lesion. A rare entity. Management strategy. Romanian Neurosurgery. 2020 Dec 1;34(4).
11. Anurag P, Rajeev B, Radheyshyam M. Factors affecting outcome in posterior fossa EDH: an analytical study at the tertiary referral hospital. Romanian Neurosurgery. 2016;30(2): 267-71.
12. Sobti S, Bansal S, Choudhary A, Gupta LN. Clinicoradiologic Predictors of Outcome of Posterior Fossa Extradural Hematoma: An Institutional Experience. Indian Journal of Neurotrauma. 2017;14(02/03):142-4.
13. Kircelli A, Ozel O, Can H, Sari R, Cansever T, Elmaci I. Is the presence of linear fracture a predictor of delayed posterior fossa epidural hematoma? 2016;22(4):355-360.
14. de Amorim RL, Stiver SI, Paiva WS, Bor-Seng-Shu E, Sterman-Neto H, de Andrade AF, Teixeira MJ. Treatment of traumatic acute posterior fossa subdural hematoma: report of four cases with systematic review and management algorithm. Acta neurochirurgica. 2014;156(1):199-206.
15. ASIF M, YOUNUS H. Early Diagnosis and Intervention in Epidural Hematoma of the Posterior Cranial Fossa. Pakistan Journal Of Neurological Surgery. 2016;20(4):214-8.
16. Takeuchi S, Wada K, Takasato Y, Masaoka H, Hayakawa T, Yatsushige H, Shigeta K, Momose T, Otani N, Nawashiro H, Shima K. Traumatic hematoma of the posterior fossa. InBrain Edema XV 2013 (pp. 135-138). Springer, Vienna.
17. Sencer A, Aras Y, AkcAkAyA MO, Goker B, Kırıs T, Canbolat AT. Posterior fossa epidural hematomas in children: clinical experience with 40 cases. Journal of Neurosurgery: Pediatrics. 2012;9(2):139-43.
18. Jang JW, Lee JK, Seo BR, Kim SH. Traumatic epidural haematoma of the posterior cranial fossa. British journal of neurosurgery. 2011;25(1):55-61.
Published
2021-06-14
Section
Original Articles