Successful treatment of traumatic acute posterior fossa subdural hematoma: report of two cases
| Autor: | Branka Kristek, Marko Rukovanjski, Goran Blagus, Duro Vranković, Ivan Hećimović |
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| Rok vydání: | 1999 |
| Předmět: |
Male
medicine.medical_specialty Central nervous system disease Hematoma medicine Craniocerebral Trauma Humans Glasgow Coma Scale Aged Coma Vascular disease business.industry Cistern Glasgow Outcome Scale Middle Aged medicine.disease Surgery body regions medicine.anatomical_structure Hematoma Subdural Treatment Outcome Posterior cranial fossa Cranial Fossa Posterior Acute Disease Female Neurology (clinical) medicine.symptom business Tomography X-Ray Computed |
| Zdroj: | Surgical neurology. 51(3) |
| ISSN: | 0090-3019 |
| Popis: | BACKGROUND Acute traumatic subdural hematoma of the posterior cranial fossa after a closed-head injury, excluding those in newborns, is a very rare clinical event. Generally, the outcome is poor and the overall mortality rate is high. METHODS Acute posttraumatic subdural hematomas of the posterior fossa associated with acute hydrocephalus in two patients were removed by standard suboccipital approach. Preoperatively, one patient was in a coma and the Glasgow Coma Score was 9 in another. CT scans showed obliterated mesencephalic cisterns in both cases. In the former there was a complex posterior fossa lesion, i.e., combined subdural and intracerebellar hematoma. The surgical decompression was completed 3 and 11 hours after injury, respectively. Intraoperative tapping of the lateral ventricle through a burr hole in the occipital area was performed in the latter case. RESULTS Both patients survived; one made a good recovery, (i.e., Glasgow Outcome Scale 4 in a patient who was comatose on admission), the other did not do as well (GOS 3). CONCLUSIONS Our experience justifies the policy of mandatory early operation in cases of traumatic acute subdural hematoma of the posterior fossa associated with poor neurologic condition, even in patients of advanced age. In patients with obliterated mesencephalic cisterns and/or complex posterior fossa lesions the same approach must be followed. These clinical and CT features are not necessarily predictors of a poor outcome. |
| Databáze: | OpenAIRE |
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