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Treatment of traumatic acute posterior fossa subdural hematoma: report of four cases with systematic review and management algorithm

  • Review Article - Brain Injury
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Traumatic posterior fossa subdural hematomas (SDHs) are rare lesions. Despite improvements in intensive care and surgical management of traumatic brain injuries over the last decades, the outcome for posterior fossa subdural hematomas remains poor.

Methods

We conduct a retrospective study over a 2-year period of patients sustaining traumatic brain injury and posterior fossa SDH. Additionally, a systematic review of case series published to date was performed.

Results

The incidence of posterior fossa SDH was 0,01 % (4/326). All patients in this current series had poor prognosis. Three out of four exhibited ischemic/edema lesions in postoperative CT scans leading to fourth ventricle effacement and persistent brainstem compression. Our literature review retrieved 57 patients from only seven case series. Unfavorable outcomes were seen in 63 % of patients.

Conclusions

Our data and data from the literature do not provide sufficient evidence to establish an optimal treatment strategy for posterior fossa SDH. However, based on lessons learned with these four cases, together with results from review of the literature, we propose an algorithm for the management of this rare condition.

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Authors and Affiliations

  1. Division of Neurosurgery, Hospital Das Clínicas University of Sao Paulo Medical School, São Paulo, SP, Brazil

    Robson Luis Oliveira de Amorim, Wellingson Silva Paiva, Edson Bor-Seng-Shu, Hugo Sterman-Neto, Almir Ferreira de Andrade & Manoel Jacobsen Teixeira

  2. Department of Neurosurgery, School of Medicine, University of California San Francisco, San Francisco, CA, USA

    Shirley I. Stiver

  3. 718 Alves Guimarães St., ap 112, 05410-001, São Paulo, SP, Brazil

    Robson Luis Oliveira de Amorim

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  1. Robson Luis Oliveira de Amorim
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  2. Shirley I. Stiver
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  3. Wellingson Silva Paiva
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  4. Edson Bor-Seng-Shu
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  7. Manoel Jacobsen Teixeira
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Correspondence to Robson Luis Oliveira de Amorim.

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de Amorim, R.L.O., Stiver, S.I., Paiva, W.S. et al. Treatment of traumatic acute posterior fossa subdural hematoma: report of four cases with systematic review and management algorithm. Acta Neurochir 156, 199–206 (2014). https://doi.org/10.1007/s00701-013-1850-6

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  • DOI: https://doi.org/10.1007/s00701-013-1850-6

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