Abstract：
OBJECTIVE: To analyze clinical and imaging characteristics of post-traumatic posterior fossa extradural hematoma (PFEDH).
METHODS: Between 2018 and 2022, 51 patients were admitted to our tertiary care trauma center with a diagnosis of PFEDH. The management decision was tailored by an individual consultant based on clinicoradiological findings. We did a prospective analysis of patient characteristics, radiology, clinical presentation, management, and outcome at discharge and onemonth follow-up.
RESULTS: Of the 51 patients diagnosed with a PFEDH, 45 (88.2%) were male, and six (11.8%) were female with a mean age of 31.2 years (range 2-77 years). Twenty-six patients needed surgical evacuation of the EDH, while the rest 25 patients were managed conservatively. There was one crossover patient from the conservative to the surgical arm. Road traffic accidents (RTA) were the most common cause of injury (n=35; 68.6%), followed by falls from height (n=16; 31.4%). Most patients presented with vomiting and loss of consciousness (LOC). At presentation, 30 patients (58.5%) had a GCS 15. Seven patients (13.7%) presented with a GCS of 9-14, and 14 patients (27.5%) with GCS ≤ 8. The mean EDH volume in conservatively and surgically managed patients was 14.1 and 25.1cc, respectively. Five patients (9.8%) had significant midline shift with obliteration of basal cisterns, 15 patients (29.4%) had effacement of the fourth ventricle, and 11 patients (21.5%) had the presence of hydrocephalus. All patients with features suggestive of tight posterior fossa (hydrocephalus, obliterated basal cisterns, and fourth ventricle compression) needed surgical intervention. Of the 25 conservatively managed patients, 24 (96%) had favorable GOS scores at discharge, while one (4%) had an unfavorable score. 16/26 (61.5%) surgically treated patients had a good outcome at discharge (GOS=4-5), while ten patients (38.4%) had adverse outcomes (GOS < 4). Initial EDH volume was inversely correlated with presenting GCS and GOS with a mean volume of 21.5 ± 8.5 cc in patients presenting with a GCS ?8. Patients with a GCS of 15 at presentation had a mean EDH volume of 16.1 ± 8.2 cc. Patients with smaller EDH had much higher GOS scores than patients with higher volume EDH (GOS 1 = 22.0 ± 9.83 cc vs. GOS 5 = 18.9 ± 12.2 cc). Outcomes mainly depended on factors like GCS at arrival and associated supratentorial, thoracic/ abdominal polytrauma.
CONCLUSIONS: In patients with a clot volume of < 15 cm3 and GCS of 15 at presentation with no mass effect and absence of tight posterior fossa, a conservative trial under strict clinicoradiological monitoring in a neuro-critical multidisciplinary setting can be offered with good results. In cases of altered GCS, findings of a TPF, or clinicoradiological deterioration, immediate surgery is warranted.
METHODS: Between 2018 and 2022, 51 patients were admitted to our tertiary care trauma center with a diagnosis of PFEDH. The management decision was tailored by an individual consultant based on clinicoradiological findings. We did a prospective analysis of patient characteristics, radiology, clinical presentation, management, and outcome at discharge and onemonth follow-up.
RESULTS: Of the 51 patients diagnosed with a PFEDH, 45 (88.2%) were male, and six (11.8%) were female with a mean age of 31.2 years (range 2-77 years). Twenty-six patients needed surgical evacuation of the EDH, while the rest 25 patients were managed conservatively. There was one crossover patient from the conservative to the surgical arm. Road traffic accidents (RTA) were the most common cause of injury (n=35; 68.6%), followed by falls from height (n=16; 31.4%). Most patients presented with vomiting and loss of consciousness (LOC). At presentation, 30 patients (58.5%) had a GCS 15. Seven patients (13.7%) presented with a GCS of 9-14, and 14 patients (27.5%) with GCS ≤ 8. The mean EDH volume in conservatively and surgically managed patients was 14.1 and 25.1cc, respectively. Five patients (9.8%) had significant midline shift with obliteration of basal cisterns, 15 patients (29.4%) had effacement of the fourth ventricle, and 11 patients (21.5%) had the presence of hydrocephalus. All patients with features suggestive of tight posterior fossa (hydrocephalus, obliterated basal cisterns, and fourth ventricle compression) needed surgical intervention. Of the 25 conservatively managed patients, 24 (96%) had favorable GOS scores at discharge, while one (4%) had an unfavorable score. 16/26 (61.5%) surgically treated patients had a good outcome at discharge (GOS=4-5), while ten patients (38.4%) had adverse outcomes (GOS < 4). Initial EDH volume was inversely correlated with presenting GCS and GOS with a mean volume of 21.5 ± 8.5 cc in patients presenting with a GCS ?8. Patients with a GCS of 15 at presentation had a mean EDH volume of 16.1 ± 8.2 cc. Patients with smaller EDH had much higher GOS scores than patients with higher volume EDH (GOS 1 = 22.0 ± 9.83 cc vs. GOS 5 = 18.9 ± 12.2 cc). Outcomes mainly depended on factors like GCS at arrival and associated supratentorial, thoracic/ abdominal polytrauma.
CONCLUSIONS: In patients with a clot volume of < 15 cm3 and GCS of 15 at presentation with no mass effect and absence of tight posterior fossa, a conservative trial under strict clinicoradiological monitoring in a neuro-critical multidisciplinary setting can be offered with good results. In cases of altered GCS, findings of a TPF, or clinicoradiological deterioration, immediate surgery is warranted.
摘要：
目的：外伤性后颅窝硬膜外血肿（PFEDH）是一种相对罕见的实体，具有非特异性的临床表现和治疗。这项研究的目的是对保守治疗与手术减压进行比较分析。
方法：在2018年至2022年期间，51例PFEDH患者入院。管理决策是根据临床放射学结果量身定制的。我们对患者特征进行了前瞻性分析，放射学,临床表现,管理,以及出院和一个月的结果。
结果：45/51（88.2％）为男性，平均年龄31.2岁（2-77岁）。26名患者需要手术撤离，而25个是保守管理的。有一名从保守到手术臂的交叉患者。道路交通事故（RTA）是最常见的伤害原因（n=35；68.6％），其次是高处坠落（n=16；31.4%）。大多数患者出现呕吐和意识丧失。在介绍时,30例患者(58.5%)的GCS为15。7例患者（13.7％）的GCS为9-14，14例患者（27.5％）的GCS≤8。保守和手术治疗患者的平均EDH体积为14.1和25.1cc，分别。5例患者（9.8％）出现明显的中线移位，伴有基底池闭塞，15例（29.4%）患者第四脑室消失，11例患者(21.5%)存在脑积水。24/25（96％）保守管理的患者出院时GOS评分良好。16/26（61.5％）手术治疗的患者出院时结果良好（GOS=4-5），而10例患者(38.4%)有不良结局(GOS4)。在GCS≤8的患者中，初始EDH体积与GCS和GOS呈负相关，平均体积为21.5±8.5cc。
结论：在出现血块体积为15cm3且GCS为15的患者中，没有肿块效应且没有TPF，在神经关键多学科背景下,在严格的临床放射学监测下进行的保守试验可获得良好的结果.在GCS改变的情况下，TPF的发现，或临床放射恶化，立即手术是必要的。
方法：在2018年至2022年期间，51例PFEDH患者入院。管理决策是根据临床放射学结果量身定制的。我们对患者特征进行了前瞻性分析，放射学,临床表现,管理,以及出院和一个月的结果。
结果：45/51（88.2％）为男性，平均年龄31.2岁（2-77岁）。26名患者需要手术撤离，而25个是保守管理的。有一名从保守到手术臂的交叉患者。道路交通事故（RTA）是最常见的伤害原因（n=35；68.6％），其次是高处坠落（n=16；31.4%）。大多数患者出现呕吐和意识丧失。在介绍时,30例患者(58.5%)的GCS为15。7例患者（13.7％）的GCS为9-14，14例患者（27.5％）的GCS≤8。保守和手术治疗患者的平均EDH体积为14.1和25.1cc，分别。5例患者（9.8％）出现明显的中线移位，伴有基底池闭塞，15例（29.4%）患者第四脑室消失，11例患者(21.5%)存在脑积水。24/25（96％）保守管理的患者出院时GOS评分良好。16/26（61.5％）手术治疗的患者出院时结果良好（GOS=4-5），而10例患者(38.4%)有不良结局(GOS4)。在GCS≤8的患者中，初始EDH体积与GCS和GOS呈负相关，平均体积为21.5±8.5cc。
结论：在出现血块体积为15cm3且GCS为15的患者中，没有肿块效应且没有TPF，在神经关键多学科背景下,在严格的临床放射学监测下进行的保守试验可获得良好的结果.在GCS改变的情况下，TPF的发现，或临床放射恶化，立即手术是必要的。
