Management of Epidural Hematomas of the Posterior Cranial Fossa

Introduction: Epidural hematoma of the posterior fossa (EDHPF) may complicate trauma to the skull base. These lesions are found to be mostly of venous origin. There has been some controversy about their proper management. Our approach has generally been conservative toward EDHPF.

Methods: We retrospectively reviewed prospectively gathered data on patients consecutively diagnosed with acute EDHPF during the years 2007–2018 at our institution.

Results: A total of 30 patients (22 males, 8 females; age range 2–47 years; mean 17.1 years) were included. Mechanisms of trauma were vehicular accidents (n = 14), falls (n = 9), assaults (n = 3), and other (n = 4). Eight patients presented in a coma. All EDHPF were diagnosed using computed tomography (CT). In half the EDHPF the clot extended supratentorial. In 14 patients an immediate (within hours or days) progression was identified on follow-up CT. Eight patients had intracranial neurosurgical interventions. Three patients had surgery for the EDHPF specifically (one drain placement to treat hydrocephalus caused by the EDHPF and two craniotomies to treat the expanding supratentorial component of the EDHPF). Four patients died from their associated head injuries and 1 remained in a permanent coma. None of the patients had a dismal outcome (death or coma) specifically from their EDHPF. On the last follow-up (1 week to 85 months, mean 20 months) 18 EDHPF had resolved completely or were in the process of dissolving based on CT.

Conclusion: The vast majority of EDHPF can be managed conservatively even if initial progression has been detected radiographically. Most symptomatic patients are due to other intracranial injuries rather than from the EDHPF and typically, these injuries are the ones that may lead to death or coma.

Publication History

Article published online:
15 February 2022