Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients

Abstract

Purpose: Posterior fossa epidural hematomas (PFEDH) are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination mini-craniectomy.

Methods: We retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015.

Results: During this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications.

Conclusion: Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.

Keywords: Pediatrics; Posterior fossa epidural hematoma; Trephination mini-craniectomy.

Fig. 1

Preoperative (A) and postoperative (B) CT scans showed that a left occipital epidural hematoma in a 6-year-old boy was evacuated by one trephination mini-craniectomy surgery. Preoperative (C) and postoperative (D) CT scans showed that a left occipital epidural hematoma in a 10-year-old girl was evacuated by one trephination mini-craniectomy surgery.