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Axial Convex-Shaped Hematoma was Associated with Poor Curative Effect of Surgical Treatment for Traumatic Posterior Fossa Epidural Hematoma in Children

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Abstract

Background

Posterior fossa epidural hematoma (PFEDH) is rare which accounts for just 4–12.9% of all EDH cases. Since its frequently subtle and nonspecific clinical presentation, CT scan has great importance for early diagnosis and treatment of PFEDH. However, indications for surgery depending on the findings of CT image are still controversial.

Methods

We retrospectively analyzed 40 pediatric cases of PFEDH. Their baseline characteristic, clinical presentation, imaging findings and outcomes were collected and analyzed. The ellipsoid volume equation X × Y × Z/2 was used to measure the hematoma volume. The Glasgow Outcome Scale (GOS) was used to assess the neurologic functional outcome.

Results

A total of 40 pediatric PFEH patients were included with 8 patients having poor outcome and 32 patients having a relatively good prognosis. GCS score showed a significant difference between good and poor outcome groups (p < 0.001). Y value on CT image was significantly bigger in poor outcome group than good outcome group (p < 0.01). Similar results were got in X/Z value (p < 0.05) and Y/Z value (p < 0.01) which reflected the shape of hematoma. A predictive model with Y + X/Z showed the largest area under the ROC curve with a sensitivity of 75.0% and specificity of 93.7%.

Conclusions

GCS score at admission was closely related to the prognosis of the pediatric patients with PFEDH. The morphometry of PFEDH has a crucial role in judging the prognosis. Axial convex-shaped hematoma was associated with poor curative effect of surgical treatment.

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References

  1. Ammirati M, Tomita T (1984) Posterior fossa epidural hematoma during childhood. Neurosurgery 14:541–544

    Article  CAS  PubMed  Google Scholar 

  2. Choux M, Grisoli F, Peragut JC (1975) Extradural hematomas in children. 104 cases. Childs Brain 1:337–347

    CAS  PubMed  Google Scholar 

  3. Kaushik S, Sandip C (2018) Posterior fossa acute extradural hematoma in children: review and management guidelines. J Pediatr Neurosci 13:289–293

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ciurea AV, Nuteanu L, Simionescu N et al (1993) Posterior fossa extradural hematomas in children: report of nine cases. Childs Nerv Syst 9:224–228

    Article  CAS  PubMed  Google Scholar 

  5. Mohanty A, Kolluri VR, Subbakrishna DK et al (1995) Prognosis of extradural haematomas in children. Pediatr Neurosurg 23:57–63

    Article  CAS  PubMed  Google Scholar 

  6. Peter JC, Domingo Z (1990) Subacute traumatic extradural haematomas of the posterior fossa: a clinicopathological entity of the 5- to 10-year-old child. Childs Nerv Syst 6:135–138

    Article  CAS  PubMed  Google Scholar 

  7. Dirim BV, Oruk C, Erdogan N et al (2005) Traumatic posterior fossa hematomas. Diagn Interv Radiol 11:14–18

    PubMed  Google Scholar 

  8. Neubauer UJ (1987) Extradural haematoma of the posterior fossa. Twelve years experiences with CT-scan. Acta Neurochir (Wien) 87:105–111

    Article  CAS  PubMed  Google Scholar 

  9. Johnson DL, Duma C, Sivit C (1992) The role of immediate operative intervention in severely head-injured children with a Glasgow Coma Scale score of 3. Neurosurgery 30:320–323. (Discussion 323–324)

  10. Lubillo S, Bolanos J, Carreira L et al (1999) Prognostic value of early computerized tomography scanning following craniotomy for traumatic hematoma. J Neurosurg 91:581–587

    Article  CAS  PubMed  Google Scholar 

  11. Ironside N, Chen CJ, Dreyer V et al (2020) Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage. Int J Stroke 15:90–102

    Article  PubMed  Google Scholar 

  12. Broderick JP, Brott TG, Duldner JE et al (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987–993

    Article  CAS  PubMed  Google Scholar 

  13. Petersen OF, Espersen JO (1984) Extradural hematomas: measurement of size by volume summation on CT scanning. Neuroradiology 26:363–367

    Article  CAS  PubMed  Google Scholar 

  14. Kothari RU, Brott T, Broderick JP et al (1996) The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:1304–1305

    Article  CAS  PubMed  Google Scholar 

  15. Han K, Li Z, Yin H et al (2018) Liquid posterior fossa epidural hematoma in pediatric trauma: a single-center case series. J Neurol Surg A Cent Eur Neurosurg 79:380–385

    Article  PubMed  Google Scholar 

  16. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484

    Article  CAS  PubMed  Google Scholar 

  17. Jamous MA, Samara QA, Jbarah OF et al (2021) Management of traumatic posterior fossa epidural hematomas in pediatrics: our experience and review of the literature. Childs Nerv Syst 37:2839–2846

    Article  PubMed  Google Scholar 

  18. Gupta PK, Mahapatra AK, Lad SD (2002) Posterior fossa extradural hematoma. Indian J Pediatr 69:489–494

    Article  CAS  PubMed  Google Scholar 

  19. Prasad GL, Gupta DK, Sharma BS et al (2015) Traumatic pediatric posterior fossa extradural hematomas: a tertiary-care trauma center experience from India. Pediatr Neurosurg 50:250–256

    Article  PubMed  Google Scholar 

  20. Sencer A, Aras Y, Akcakaya MO et al (2012) Posterior fossa epidural hematomas in children: clinical experience with 40 cases. J Neurosurg Pediatr 9:139–143

    Article  PubMed  Google Scholar 

  21. Chaoguo Y, Xiu L, Liuxun H et al (2019) traumatic posterior fossa epidural hematomas in children: experience with 48 cases and a review of the literature. J Korean Neurosurg Soc 62:225–231

    Article  PubMed  PubMed Central  Google Scholar 

  22. Malik NK, Makhdoomi R, Indira B et al (2007) Posterior fossa extradural hematoma: our experience and review of the literature. Surg Neurol 68:155–158. (Discussion 158)

  23. Bor-Seng-Shu E, Aguiar PH, de Almeida Leme RJ et al (2004) Epidural hematomas of the posterior cranial fossa. Neurosurg Focus 16:ECP1

  24. Harwood-Nash DC, Hendrick EB, Hudson AR (1971) The significance of skull fractures in children. A study of 1,187 patients. Radiology 101:151–156

    Article  CAS  PubMed  Google Scholar 

  25. Singh S, Ramakrishnaiah RH, Hegde SV et al (2016) Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings. Pediatr Radiol 46:67–72

    Article  PubMed  Google Scholar 

  26. Pasaoglu A, Orhon C, Koc K et al (1990) Traumatic extradural haematomas in pediatric age group. Acta Neurochir (Wien) 106:136–139

    Article  CAS  PubMed  Google Scholar 

  27. Jamjoom A, Cummins B, Jamjoom ZA (1994) Clinical characteristics of traumatic extradural hematoma: a comparison between children and adults. Neurosurg Rev 17:277–281

    Article  CAS  PubMed  Google Scholar 

  28. Bullock MR, Chesnut R, Ghajar J et al (2006) Surgical management of posterior fossa mass lesions. Neurosurgery 58:S47–55. (Discussion Si–iv)

  29. Berker M, Cataltepe O, Ozcan OE (2003) Traumatic epidural haematoma of the posterior fossa in childhood: 16 new cases and a review of the literature. Br J Neurosurg 17:226–229

    Article  CAS  PubMed  Google Scholar 

  30. Pozzati E, Tognetti F, Cavallo M et al (1989) Extradural hematomas of the posterior cranial fossa. Observations on a series of 32 consecutive cases treated after the introduction of computed tomography scanning. Surg Neurol 32:300–303

    Article  CAS  PubMed  Google Scholar 

  31. Faheem M, Jaiswal M, Ojha BK et al (2019) Traumatic pediatric extradural hematoma: an institutional study of 228 patients in tertiary care center. Pediatr Neurosurg 54:237–244

    Article  PubMed  Google Scholar 

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Acknowledgements

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Funding

This work was funded by National Natural Science Youth Foundation of China (No. 81602204) and Hubei Province Association of Pathophysiology (No. 2021HBAP007).

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Authors and Affiliations

  1. Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Zhuangzhuang Miao, Jin Lei, Yu Li, Xueyan Wan, Kai Zhao, Hongquan Niu & Ting Lei

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  1. Zhuangzhuang Miao
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  2. Jin Lei
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Contributions

Dr. ZM and Dr. YL were involved in investigation and data acquisition. Dr. JL took part in study design. The original manuscript was written by Dr. ZM and edited by Dr XW. Dr KZ participated in statistical analysis and critical revision of the manuscript. Dr HN and Dr. TL took part in project concept.

Corresponding author

Correspondence to Kai Zhao.

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Conflict of interest

The authors declare that they have no conflict of interest.

Patient consent was waived as this retrospective study had no effect on the rights, health, or privacy of the subjects. The risk to the subjects of the study was not greater than the minimum risk.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki and approved by the Medical Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (protocol code, TJ-IRB20220921; date of approval, 9 September 2022).

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Miao, Z., Lei, J., Li, Y. et al. Axial Convex-Shaped Hematoma was Associated with Poor Curative Effect of Surgical Treatment for Traumatic Posterior Fossa Epidural Hematoma in Children. World J Surg 47, 2932–2939 (2023). https://doi.org/10.1007/s00268-023-07161-8

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  • DOI: https://doi.org/10.1007/s00268-023-07161-8

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