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Pediatric retroclival hematomas

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Abstract

Background

Traumatic retroclival hematomas (RCHs) are infrequent occurrences among the pediatric population. The existing body of research pertaining to these hematomas primarily consists of case reports or small case series, which do not provide adequate guidance for managing this condition.

Objective

This study aims to present a report on four cases of RCHs. Additionally, we aim to conduct a systematic review to consolidate the existing literature on pediatric RCHs.

Methods

The authors conducted a systematic review in accordance with the PRISMA and CARE guidelines. A multivariate logistic regression model was developed to evaluate the potential impact of various clinical variables on clinical outcomes. The study also documented four of our cases, one of which was a rare occurrence of spontaneous subdural RCH.

Results

A total of 62 traumatic RCHs have been documented in the literature. We documented three cases of traumatic RCHs and one case of spontaneous RCH. A systematic analysis of 65 traumatic RCHs was performed. Of trauma cases, 64.6% demonstrated craniocervical junction instability with 83.3% ligamentous involvement. Thirty-five patients were males. 50.7% were aged between 5 and 9 years. Cranial nerve palsies occurred in 29 patients (27 had abducent palsy), 26 of which resolved within 6 months of trauma. 23.5% underwent surgery, and 76.5% were conservatively managed. Surgeries targeted hematomas, hydrocephalus, or craniocervical instability. Approaches to hematomas included transclival and far/extreme lateral suboccipital approaches. Clinical outcome was good in 75.4% and intermediate or poor in 24.6%. Logistic regression suggested an association between craniocervical junction injuries and poor or intermediate outcomes (OR 4.88, 95% CI (1.17, 27.19), p = 0.04).

Conclusion

Pediatric RCHs are mostly traumatic and extradural. Children between 5 and 9 years old are most vulnerable. Craniocervical junction injuries, mainly ligamentous, are common in RCHs and are associated with intermediate or poor outcomes. Cervical MRI could be important in cases of trauma to rule out ligamentous injuries of the craniocervical junction. The small size of RCHs should not exempt the careful assessment of craniocervical junction instability. Cranial nerve palsies are common and usually resolve within 6 months. Conservative treatment is typical unless brainstem compression, hydrocephalus, or craniocervical junction instability exists.

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Availability of data and material

The data and material are available on contact with Y. H. K., email yakhormi@jazanu.edu.sa.

Abbreviations

CARE:

CaSe reports checklist guidelines

CVJI:

Craniocervical junction injury

CSF:

Cerebrospinal fluid

CT:

Computed tomography

ER:

Emergency room

EVD:

External ventricular drain

ICU:

Intensive care unit

MVA:

Motor vehicle accident

SDH:

Subdural hematoma

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

RCH:

Retroclival hematoma

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Author information

Authors and Affiliations

  1. Department of Surgery, Neurosurgery Division, Jazan University, Al Maarifah Road, PO Box 114, 45142, Jazan, Saudi Arabia

    Yahya H. Khormi

  2. Department of Neurosurgery, King Fahd Central Hospital, Jazan, Saudi Arabia

    Yahya H. Khormi, Adel Ibrahim Hanbashi & Mostafa M. E. Atteya

  3. Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia

    Mohamed M. Aly

  4. Department of Neurosurgery, Mansoura University, Mansoura, Egypt

    Mohamed M. Aly

  5. Department of Radiology, Emergency Division, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA

    Hossam K. Hamda

  6. Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia

    Aly Abdelrahman Yousef

  7. Department of Pediatrics, Faculty of Medicine, Helwan University, Cairo, Egypt

    Aly Abdelrahman Yousef

Authors
  1. Yahya H. Khormi
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  6. Mostafa M. E. Atteya
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Contributions

Study concept and design (Y. H. K. and M. M. E. A.) data acquisition and analysis (M. M. E. A. and A. I. H.), evaluation and re-classification of all published radiographs (H.H., M. M. E. A., and A. I. H.), writing of manuscript, figure design, table design, critically revising manuscript, and review of submitted manuscript: (all authors), study supervision (M. M. E. A.).

Corresponding author

Correspondence to Yahya H. Khormi.

Ethics declarations

Ethical approval and consent to participate

This systematic review was not registered in PROSPERO or other review databases. No IRB/ethics committee approval was needed for this case presentation and systematic review. We conducted our study following the principles outlined in the Declaration of Helsinki.

Consent for publication

Written consent was obtained in our four cases from the parents or the legal guardians.

Conflict of interest

The authors declare no conflict of interests.

Disclaimer

The topic was presented as a poster presentation in the 48th Annual Meeting of the International Society for Pediatric Neurosurgery (ISPN), 06–10 December 2022, Singapore. Part of this work was accepted and presented as an oral presentation in 16th Annual Meeting of the Saudi Association of Neurological Surgery (SANS), Riyadh, KSA, 25–27 March 2022.

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Khormi, Y.H., Aly, M.M., Hamda, H.K. et al. Pediatric retroclival hematomas. Childs Nerv Syst 40, 1389–1404 (2024). https://doi.org/10.1007/s00381-023-06233-3

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