Traumatic epidural hematomas in posterior cranial fossa

Abstract

Epidural hematoma of the posterior cranial fossa (EHPCF) is a rare complication in head injuries. Furthermore, nonspecific clinical signs and the rare occurrence of this lesion in craniocerebral injuries make the establishment of a diagnosis more difficult. The aim of the paper is to point to the advantages of early diagnosis. During the 1982-2008 period, 18 patients with EHPCF were operated on at University Department of Neurosurgery, Clinical Center of Montenegro in Podgorica. The clinical picture, neuroradiological examination findings and outcome of operated patients were retrospectively analyzed. In our patient series, EHPCF accounted for 0.11% of craniocerebral injuries or 7.9% of epidural hematomas recorded. In 11 cases, the injury was inflicted in traffic accidents and in 7 patients it was caused by fall. Linear fracture of the occipital bone was detected by radiographic investigation in 12, isolated diastasis fracture of lambdoid suture in four, and linear fracture of the occipital bone with diastasis fracture of lambdoid suture in two patients. Glasgow Coma Scale of 8 and less was present in three, 9-12 in seven, and 13-15 in eight patients. The majority of cases (90%) were detected within 24 hours. In all cases, the diagnosis was made by computed tomography. Mortality rate was 11.11%. Early computed tomography of the head in combination with clinical picture and timely surgical intervention could reduce the mortality and morbidity in these lesions.