Trephine craniotomy for evacuation of posterior fossa extradural hematoma

Abstract

Extradural hematomas (EDH) commonly occur in the supratentorial region where these are evacuated by trephine or craniotomy. Posterior fossa EDH (PFEDH) account for 4% to 12.9% of all cranial EDH and the standard method for evacuation of PFEDH involves a suboccipital craniectomy. Use of a trephine craniotomy for evacuation of PFEDH has not yet been described. This is the first report describing our experience in 8 patients with PFEDH where a sub occipital trephine craniotomy was used for evacuation of PFEDH. Eight patients with PFEDH were operated at our institution using a trephine for making a sub occipital craniotomy. Park bench position was used in all patients. The procedure was safely and expeditiously completed with no significant peri-operative complications related to the procedure. Operative time was comparatively shorter than for traditionally described procedures. Replacing the bone flap also avoids any scope for the possibility of occurrence of the sinking skin flap syndrome. We think that using a trephine for making a sub occipital craniotomy for evacuation of PFEDH is a feasible and safe option. There is no added risk of venous sinus injury. Replacing the bone flap helps to restore the normal anatomy. Use of central and peripheral dural hitch sutures in patients of traumatic PFEDH is feasible and avoids any possible reaccumulation of hematoma.

Keywords

epidural hematoma - posterior fossa surgery - trephine

• References

• 1 Mahajan RK, Sharma BS, Khosla VK. et al Posterior fossa extradural haematoma—experience of nineteen cases. Ann Acad Med Singapore 22 (Suppl. 03) Suppl 1993; 410.1-413.1
• 2 Wang EC M, Lim AY T, Yeo TT. Traumatic Posterior Fossa Extradural Haematomas (PFEDH). Singapore Medical Journal 09 (03) 1998; 107.2-111.2
• 3 Garza-Mercado R. Extradural haematoma of the posterior cranial fossa: Report of seven cases with survival. J Neurosurg 59 1983; 664.3-672. 3
• 4 Holzschuh M. Schuknecht. Traumatic epidural haematomas of the posterior fossa: 20 new cases and a review of the literature since 1961. Br J Neurosurg 03 (02) 1989; 171.4-180.4
• 5 Pozzati E, Tognetti F, Cavallo M, Acciarri N. 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 (04) 1989; 300.5-303.5
• 6 Lui TN, Lee ST, Chang CN, Cheng WC. Epidural haematomas in the posterior cranial fossa. J Trauma 34 (02) 1993; 211-215
• 7 Apuzzo M. (ed) Brain Surgery: complication avoidance and management. 1947. Churchill; Livingstone, NY: 7
• 8 Schmidek HH, Sweet WH. Operative Neurosurgical Techniques: Indication, Methods and results. (3^rd edition): pp 69 – 74. 8
• 9 Yurtseven Taþýn, Ýþel Sertaç, Tabur Ender. Successful management of adults traumatic posterior fossa haematomas with zero mortality. Journal of Neurological Sciences (Turkish) 21 2004; 2 http://Www.Med.Ege.Edu.Tr/Norolbil/2004/Nbd28504.Htm (Accessed 11.5.2006)9
• 10 Berker M, Cataltepe O, Ozcan OE. Traumatic epidural haematoma of the posterior fossa in childhood: 16 new cases and a review of the literature. Br J Neurosurg 17 (03) 2003; 226.10-229.10
• 11 Lobato RD, Rivas JJ, Cordobes F, Alted E, Perez C, Sarabia R. Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg 68 (01) 1988; 48-57
• 12 Erdogan E, Düz B, Kocaoglu M, Izci Y, Sirin S, Timurkaynak E. The effect of cranioplasty on cerebral hemodynamics: Evaluation with transcranial doppler sonography. Neurol India 51 2003; 479.12-481.12
• 13 Tabaddor K, LaMorgese J. Complication of a large cranial defect-Case report. J Neurosurg 44 1976; 506.13-508.13