Posterior fossa epidural hematomas: observations on a series of 73 cases

The posterior fossa is an uncommon site for epidural hematomas. Clinical pr ogress is silent and slow, but the deterioration is sudden and quick to bec ome fatal if not promptly treated. Early recognition is therefore extremely important. The recommended treatment for posterior fossa epidural hematoma is surgical evacuation soon after the diagnosis, since the posterior fossa contains vital structures. However, conservative management under close cl inical and radiological supervision can be applied in patients without mass effect. In our study, a review of 73 cases with posterior fossa epidural h ematoma among a total number of 737 patients with epidural hematoma is pres ented, and a new neuroradiological classification is proposed in order to d etermine the appropriate type of treatment. In this series, 14 patients wer e treated conservatively, while 59 required surgery. The conservatively tre ated 9 pediatric and 5 adult patients, and 51 of the 59 surgically treated cases, in other words a total of 65 of the 73 patients, showed excellent re covery; 4 patients treated surgically had a moderate disability, and 4 pati ents died (overall mortality 5.4%). The critical factors influencing outcom e were the neuroradiological class, the level of consciousness just before the operation, and the other systemic and/or intracranial traumatic lesions . In this study, the critical observation was that the neuroradiological fi ndings were earlier, more reliable and predictive than the clinical finding s. Therefore, based upon the obliteration of perimesencephalic cisterns and /or displacement of the fourth ventricle, a new neuroradiological classific ation was designed for decision-making in management.