MANAGEMENT AND OUTCOMES OF POSTERIOR-FOSSA SUBDURAL HEMATOMAS IN NEONATES

OBJECTIVE: To review and analyze a contemporary series of 15 neonates who were treated for posterior fossa subdural hematomas (PFSDHs) durin g the era of computed tomography and magnetic resonance imaging. METHO DS: A retrospective chart review identified all neonates with PFSDHs f or whom neurosurgical consultations were obtained for treatment planni ng. RESULTS: There were nine male and six female patients. The mean ge stational age was 39 weeks. Nine of the 15 mothers of the patients wer e primiparous. Instrument-assisted delivery (forceps and/or vacuum ext ractor) was undertaken for seven patients. The mean birth weight of th e infants was 3165 g (range, 2160-3930 g). The mean Ei-minute Apgar sc ore was 7.5. Symptoms of PFSDH developed within the first 24 hours of life in 13 neonates. The predominant symptoms and signs were failure t o thrive, irritability, seizures, apnea, and bradycardia. Lumbar punct ures to rule out central nervous system sepsis were performed in six n eonates. Hemograms revealed that six neonates were anemic with low hem oglobins, five had low platelets, and four had abnormal prothrombin an d/or partial thromboplastin times at the time of diagnosis. Computed t omography established the diagnosis of PFSDH in all cases. Magnetic re sonance imaging was performed for two neonates. The median time to dia gnosis by imaging studies was 10 hours after birth. Surgical evacuatio n of the PFSDHs was performed in eight neonates. Seven neonates were f ollowed conservatively with serial imaging studies. There was no morta lity in either treatment group. Follow-up ranged from 2 to 10 years, w ith a mean of 4.5 years. Functional outcome assessment revealed that s even neonates were neurodevelopmentally normal, three were mildly dela yed, two were moderately delayed, and three were profoundly delayed. I n addition to traumatic causes of the PFSDHs, three neonates were obse rved to have coagulation disturbances at birth and one was observed at follow-up to have a posterior fossa medulloblastoma that had bled at birth. CONCLUSION: PFSDHs are rare but important lesions to diagnose e arly in the neonatal period. Surgery can be life-saving when performed in a timely manner for signs and symptoms of brain stem dysfunction. A search for an underlying cause predisposing to a PFSDH may, on occas ion, reveal a coagulation disturbance or a neoplasm that will require additional therapeutic considerations.