Traumatic Epidural Hematoms in Posterior Cranial Fossa: a Clinical Study in Tertiary Care Hospital

  • SOHAIL AMIR Department of Neurosurgery Medical Teaching Institute
Keywords: Epidural hematoma, posterior cranial fossa, outcome.


Objective: To determine clinical presentation and outcome of traumatic epidural hematoma in posterior cranial fossa. Material and Methods: This descriptive case series was conducted in department of Neurosurgery Mardan Medical Complex Mardan from May 2016 to April 2017. All patients presenting with extradural hematoma in posterior fossa of either gender and age were included in the study while patients with recurrent posterior fossa extradural hematoma and hematoma at other side of the brain were excluded. CT scan Brain with bone window was done in all patients. Patients were followed for one month. Outcome was measured on the basis of GCS and GOS. Results: Total 23 patients were included in the study having age range from 8 to 58 years with mean age was34 ± 5.23 years. 16 (69.56%) were males and 7 (30.4%) were female. Road traffic accident was the most common cause of head injury in 11 (47.8%) cases. Headache and vomiting was seen in 16 (69.5%) cases, drowsiness in 8 (33%), occipital swelling in 4 (19%), otorrhea in 3 (13%) and coma in 1 (4%) case. 11 (47.8%) were managed conservatively while 12 (52.1%) were manage by surgery. Outcome measured by GOS, 15 (65.2%) fell into GOS 5, 3 (13.04%) fell into GOS 4, 7 (30.4%) into GOS 3, 6(26%) into GOS 2 and 6 (26%) into GOS 1. Conclusion: PFEDH is a traumatic substrate with poor clinical picture. Failure to diagnose the condition, level of consciousness at the time of intervention, clinical course and associated cranial injuries are the significant factors influencing morbidity and mortality from this condition. One should maintain high index of suspicion for the possibility of PFEDH in any patient with head injury.


1. Garca-Mercado R. Extrdural hematoma of posterior cranial fossa- a case report of seven cases with survival. J Neurosurg. 1983; (59): 664-72.
2. Born-Seng-Shue E, Aguiar PH, De Almeida L et al. Epidural hematoma of the posterior cranial fossa .Neu-rosurg. Focus, 2004; 16 (2): 32-7.
3. Khwaja HA, Hormbrey PJ. Posterior cranial fossa ven-ous extradural haematoma: an un common form of intracranial injury. Emerg Med. 2001; (18): 496-7.
4. Bozbuga M, Izgi N, Posterior fossa epidural hematoma: observation on 73 cases. Neurosurg Rev. 1999; (22): 34-40.
5. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauer-beck LR, Zuccarello M, Khoury J. The ABCs of mea-suring intracerebral hemorrhage volumes. Stroke, 1996; 27 (8): 1304-5.
6. Malik NK, Makhdoomi R, Indira B, Shankar S, Sastray K. Posterior fossa extradural hematoma: our experience
and review of litereature. Surg Neurol. 2007; 68 (2): 155-8.
7. Kang SH, Chung YG, Lee HK. Rapid disappearance of acute posterior fossa epidural hematoma. Neurol Med Chir (Tokyo). 2005; 45 (9): 462-3.
8. Balik V, Lehto H, Hoza D, Sulla I, Hernesniemi J, Pos-terior fossa extradural hematoma. Cent Eurr Neurosurg. 2010; 71 (4): 167-72.
9. Haq NU, Azam F, Ishfaq M, Khan BZ, Jalal A. Clinical presentation and outcome of traumatic epidural hema-toma in posterior fossa: study of 34 cases. J Postgrad Med Inst. 2016; 30 (3): 240-3.
10. Berna VD, Cuneyt O, Nezhat E, Fazil G, Engin U. Tra-umatic posterior fossa hematomas. Digninterv Radiol. 2005; 11: 14-18.
11. Bogdan A. Traumatic epidural hematomas in posterior cranial fossa. Acta Clin Croat. 2009; 48: 27-30.
12. Muhammad A, Hamza Y. Early Diagnosis and inter-vention in epidural hematoma of posterior cranial fossa. Pak J. of Neurol. Surg. 2016; 20 (4): 214-17.
13. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW et al. Surgical management of traumatic brain injury author group: surgical management of pos-terior fossa mass lesions. Neurosurgery, 2006; 58: 47-55.
14. Karasu A, Sabanci PA, Izgi N, Imer M, Sencer A, Can-sever T et al. Traumatic epidural hematoma of the pos-terior cranial fossa. Surg Neurol. 2008; 69: 247-52.
15. Jang JW, Lee JK, Seo BR, Kim SH. Traumatic epidural hematoma of the posterior fossa. Br J Neurosusrg. 2011; 25: 55-61.
16. E Bor-Seng-shu E et al. Epidural hematoma of posterior cranial fossa, Neurosurg Focus, 2004; 16: 1-4.
17. Bozhuga M, Izgi N, Polat G, et al. posterior fossa extra-dural hematoma ; observation on a series of 73 cases, Neurosurg Rev. 1999; 22: 34-40.
18. Pozzati E, Tognetti F, Cavallo M, et al. Extradural hem-atoma of the posterior cranial fossa. Observation on a series of 32 consecutive cases treated after the intro-duction of CT Scanning. Surg Neurol. 1989; 32: 300-303.
Original Articles