Subgaleal fluid collection is a rare phenomenon of scalp swelling among young infants and, in many cases, adolescents. As fluid accumulates in the subgaleal space, it presents as a soft, ill-defined, fluctuant, mobile swelling not limited to suture lines. This condition is associated with vacuum-assisted devices and forceps during delivery in infancy. Beyond infancy, this condition can be seen spontaneously or, most commonly, after minor head traumas. Such minor traumas that have been reported in recent years include hair pulling or hair braiding. Early recognition of this condition and its complications is essential for appropriate treatment and management. In this case report, we highlight the importance of subgaleal fluid collection being considered a differential diagnosis of headaches, particularly in children and adolescents who present with excessive hair pulling or hair braiding.

We present the case of a 13-year-old male with sickle cell disease (SCD) who presented to the emergency department with a severe headache secondary to calvarial infarcts with associated epidural and subgaleal hematomas. This case was complicated by external compression of the superior sagittal sinus by the hematomas as seen on magnetic resonance imaging. Management included supportive treatment of pain and swelling. This case emphasizes skull infarctions with associated hematomas as a possible differential diagnosis for patients with SCD presenting with headaches and scalp swellings.

This case report highlights an unusual manifestation of a giant subgaleal hematoma in a 15-year-old child, which progressed to a potentially life-threatening condition requiring surgical drainage. Subgaleal hematomas occur when the emissary veins between the periosteal and aponeurotic layers of the scalp rupture. In many cases, subgaleal hematomas undergo spontaneous absorption without intervention. However, in this particular case, the hematoma measured approximately 1300 ml, making it the largest documented in medical literature and necessitating surgical intervention. In cases where hematoma absorption is problematic, clinicians should consider the possibility of underlying coagulopathy or persistent trauma, such as head banging, child maltreatment, or repeated falls due to seizure attacks, as observed in this patient. While there is no universally agreed-upon treatment protocol for subgaleal hematomas, incision and drainage offer immediate relief by evacuating the collection. Employing a negative-pressure suction drain can help alleviate the loss of tamponade effect. In addition, subsequent behavioral therapy and rehabilitation efforts may enhance the overall recovery and well-being of affected individuals.

Assisted vaginal birth rates are falling globally with rising cesarean delivery rates. Cesarean delivery is not without consequence, particularly when carried out in the second stage of labor. Cesarean delivery in the second stage is not entirely protective against pelvic floor morbidity and can lead to serious complications in a subsequent pregnancy. It should be acknowledged that the likelihood of morbidity for mother and baby associated with cesarean delivery increases with advancing labor and is greater than spontaneous vaginal birth, irrespective of the method of operative birth in the second stage of labor. In this article, we argue that assisted vaginal birth is a skilled and safe option that should always be considered and be available as an option for women who need assistance in the second stage of labor. Selecting the most appropriate mode of birth at full dilatation requires accurate clinical assessment, supported decision-making, and personalized care with consideration for the woman\'s preferences. Achieving vaginal birth with the primary instrument is more likely with forceps than with vacuum extraction (risk ratio, 0.58; 95% confidence interval, 0.39-0.88). Midcavity forceps are associated with a greater incidence of obstetric anal sphincter injury (odds ratio, 1.83; 95% confidence interval, 1.32-2.55) but no difference in neonatal Apgar score or umbilical artery pH. The risk for adverse outcomes is minimized when the procedure is conducted by a skilled accoucheur who selects the most appropriate instrument likely to achieve vaginal birth with the primary instrument. Anticipation of potential complications and dynamic decision-making are just as important as the technique for safe instrument use. Good communication with the woman and the birthing partner is vital and there are various recommendations on how to achieve this. There have been recent developments (such as OdonAssist) in device innovation, training, and strategies for implementation at a scale that can provide opportunities for both improved outcomes and reinvigoration of an essential skill that can save mothers\' and babies\' lives across the world.

This case report details the complex presentation of a six-year-old female child with global developmental delay (GDD), scurvy, congenital toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and HIV (TORCH) infection and a subgaleal hematoma. The patient\'s medical history included delayed developmental milestones, bilateral congenital cataract, and a previous generalized tonic-clonic seizure. Thorough investigations revealed cerebral atrophy, bilateral ventricular dilatation, and periosteal thinning consistent with scurvy. The interdisciplinary approach involving neurology, ophthalmology, and orthopedics resolved the subgaleal hematoma. This case underscores the intricate interplay of neurological, nutritional, and infectious factors in pediatric conditions and highlights the importance of a collaborative, multidisciplinary approach for accurate diagnosis and effective management.

UNASSIGNED: Subgaleal hematoma is a well-known life-threatening complication of instrumentation at birth. Even though most cases of subgaleal hematomas occur in the neonatal period, older children and adults are also at risk for subgaleal hematomas and their complications, following head trauma.
UNASSIGNED: We hereby report the case of a 14-year-old boy who presented with a traumatic subgaleal hematoma requiring drainage and review the relevant literature regarding potential complications and indications for surgical intervention.
UNASSIGNED: Infection, airway compression, orbital compartment syndrome and anemia requiring transfusion are potential complications of subgaleal hematomas. Although rare, surgical drainage and embolization are occasionally required interventions.
UNASSIGNED: Subgaleal hematomas following head trauma can occur in children beyond the neonatal period. Large hematomas may require drainage to relieve pain or when compressive or infectious complications are suspected. Although usually not life-threatening, physicians taking care of children must be cognizant of this entity when caring for a patient with a large hematoma following head trauma and in severe cases, consider a multidisciplinary approach.

Introduction Preterm delivery (gestational age < 34 w) is a relative contraindication to vacuum extraction. Current data do not differentiate clearly between preterm delivery and low birthweight. We aimed to evaluate the impact of non-metal vacuum cup extraction on neonatal head injuries related to birth trauma in newborns with low birthweights (< 2500 g). Materials and Methods A retrospective cohort of 3377 singleton pregnancies delivered by vacuum extraction from 2014 to 2019. All were gestational age ≥ 34 w. We compared 206 (6.1%) neonates with low birthweights < 2500 g to 3171 (93.9%) neonates with higher birthweights, divided into 3 subgroups (2500-2999 g, 3000-3499 g, and ≥ 3500 g). A primary composite outcome of neonatal head injuries related to birth trauma was defined. Results The lowest rates of subgaleal hematoma occurred in neonates < 2500 g (0.5%); the rate increased with every additional 500 g of neonatal birthweight (3.5%, 4.4% and 8.0% in the 2500-2999 g, 3000-3499 g, and ≥ 3500 g groups, respectively; p = 0.001). Fewer cephalohematomas occurred in low birthweight neonates (0.5% in < 2500 g), although the percentage increased with every additional 500 g of birthweight (2.6%, 3.3% and 3.7% in the 2500-2999 g, 3000-3499 g, and ≥ 3500 g groups, respectively, p = 0.020). Logistic regression found increasing birthweight to be a significant risk factor for head injuries during vacuum extraction, with adjusted odds ratios of 8.12, 10.88, and 13.5 for 2500-2999 g, 3000-3499 g, and ≥ 3500 g, respectively (p = 0.016). NICU hospitalization rates were highest for neonates weighing < 2500 g (10.2%) compared to the other groups (3.1%, 1.7% and 3.3% in 2500-2999 g, 3000-3499 g, ≥ 3500 respectively, p < 0.001). Conclusions Vacuum extraction of neonates weighing < 2500 g at 34 w and beyond seems to be a safe mode of delivery when indicated, with lower rates of head injury related to birth trauma, compared to neonates with higher birthweights.
Einleitung Frühgeburtlichkeit (Schwangerschaftsalter < 34 SSW) ist eine relative Kontraindikation für eine Vakuumextraktion. Die aktuellen Daten machen aber keine klare Unterscheidung zwischen Frühgeburt und niedrigem Geburtsgewicht. Ziel unserer Studie war es, die Auswirkungen einer nicht metallenen Saugglocke auf geburtsbedingte Kopfverletzungen bei Neugeborenen mit niedrigem Geburtsgewicht (< 2500 g) zu evaluieren. Material und Methoden Es wurde eine retrospektive Untersuchung einer Geburtskohorte durchgeführt, bestehend aus 3377 Einlingsschwangerschaften, die zwischen 2014 und 2019 mit Vakuumextraktion entbunden wurden. Das Schwangerschaftsalter aller untersuchten Schwangerschaften war ≥ 34 SSW. Die Studie verglich 206 (6,1%) Neugeborenen mit niedrigem Geburtsgewicht (< 2500 g) mit 3171 (93,9%) Neugeborenen mit höherem Geburtsgewicht, wobei letztere in 3 Untergruppen (2500–2999 g, 3000–3499 g und ≥ 3500 g) unterteilt wurde. Der primäre kombinierte Endpunkt wurde als geburtstraumabedingte Kopfverletzungen bei Neugeborenen definiert. Ergebnisse Die niedrigste Rate an subgalealen Hämatomen fand sich in der Gruppe von Neugeborenen mit einem Geburtsgewicht von < 2500 g (0,5%); die Rate nahm mit jedem zusätzlichen 500 g an Geburtsgewicht zu (3,5%, 4,4% bzw. 8,0% jeweils für die 2500–2999-g-, 3000–3499-g- bzw. ≥ 3500-g-Gruppe; p = 0,001). Es traten weniger Kephalhämatome in der Gruppe der Neugeborenen mit niedrigem Geburtsgewicht auf (0,5% in der < 2500-g-Gruppe), aber der Prozentsatz nahm mit jedem zusätzlichen 500 g an Geburtsgewicht zu (2,6%, 3,3% bzw. 3,7% für die 2500–2999-g-, 3000–3499-g- bzw. ≥ 3500-g-Gruppen, p = 0,020). Nach der logistischen Regressionsanalyse war zunehmendes Geburtsgewicht ein signifikanter Risikofaktor für vakuumbedingte Kopfverletzungen, mit einem angepassten Chancenverhältnis von jeweils 8,12, 10,88 bzw. 13,5 für die 2500–2999-g-, 3000–3499-g- bzw. ≥ 3500-g-Gruppe (p = 0,016). Neugeborenen mit einem Geburtsgewicht von < 2500 g (10,2%) hatten die höchsten Einweisungsraten auf die Neugeborenenintensivstation verglichen mit den anderen Gruppen (3,1%, 1,7% bzw. 3,3% für die 2500–2999-g-, 3000–3499-g- bzw. ≥ 3500-g-Gruppe, p < 0,001). Schlussfolgerungen Wenn eine Vakuumentbindung indiziert ist, scheint die Vakuumextraktion von Neugeborenen mit einem Geburtsgewicht von < 2500 g in der 34. SSW und danach ein sicherer Entbindungsmodus zu sein, der mit niedrigeren geburtsbedingten Kopfverletzungsraten assoziiert ist, verglichen mit Neugeborenen mit einem höheren Geburtsgewicht.

Subgaleal drainage is often being used in craniotomy procedures. It\'s not only offers advantages but also carries a risk of life-threatening complications. Here, we present a rare case of subgaleal hematoma and skin necrosis caused by placement of subgaleal drainage in a pediatric patient after a craniotomy procedure.
We reported a 6-months-old child who came to our institution complaining of uncontrolled eye movements which occurred 4 months earlier. From the CT scan and MRI, it was found that the patient had a mass in his suprasellar region, which suggested a suprasellar tumor. She underwent a mass resection procedure, but unfortunately, 3 days after the surgical procedure, the wound appeared necrotic, with a blackish color around the drain. The necrotic wound was suspected due to vacuum subgaleal drain placement. The wound was cleaned and the suture removed, but the necrotic area was still there. Four days after the surgery, the patient clinical condition got worse. After 17 days of treatment with no significant improvement, unfortunately, the patient died.
The mechanism of subgaleal hematoma and skin necrosis induced by the Redon drain possibly related to mechanical compression by the drain, which damage perforating vessels and subsequently disrupt skin vascularization, combined with vascular stasis as given by negative pressure of the drain. This induced skin ischemia lesion which later contributes the necrotic formation.
The subgaleal hematoma and skin necrosis as a complication of subgaleal redon drain in pediatric are rare phenomenon and likely under reported. The possible underlying mechanism was that drain\'s negative pressure disrupt subgaleal tissue and induce necrotic formation. Even the complication is rare compared to older children, yet it has been linked to an increased risk for infection, morbidity, and mortality.

UNASSIGNED: A subgaleal hematoma (SGH) describes scalp bleeding in the potential space between the periosteum and the galea aponeurosis. This hematoma generally occurs after vacuum-assisted and forceps delivery, but may also be seen following head trauma. Despite its benign course, SGHs may complicate by life-threatening events.
UNASSIGNED: We report a case of a 10-year-old male with Ehlers-Danlos syndrome presenting with scalp swelling following minor head trauma. On examination, a small swelling was observed in the occipital region. During the follow up, as the volume of subgaleal hematoma was increasing, we performed needle aspiration to achieve volume reduction, and dressed with a cap like bandage that wrapped and compressed scalp. The patient was hospitalized due to hemodynamic instability and a blood transfusion was performed. Due to extended usage of compressive bandage, a large area of scalp tissue became necrotic. The necrotic scalp tissue was debrided and reconstructed by plastic and reconstructive surgery. After surgery, another hematoma formed extending from the front of the ear to the ipsilateral neck caused facial paralysis, this hematoma was evacuated and a drain was placed. The patient was followed up for 1 year and no recurrent cephalhematoma was observed.
UNASSIGNED: Ehlers-Danlos is a rarely encountered connective tissue syndrome, this case underscores the importance for neurosurgery physicians to recognize the potential catastrophes, these patients may present with following even minor injury.

Proptosis after a subgaleal hematoma (SGH) is a rare condition that may require immediate intervention to prevent visual loss. A 12-year-old boy presented with localized SGH in the left parietal area after hair-pulling. The SGH was massively expanded on the entire scalp on the 3rd day of the trauma. On the next day after the massive expansion, proptosis of the right eye occurred suddenly. Emergent needle aspiration of the SGH was performed, and the proptosis improved slightly. Fortunately, his vision did not deteriorate. After all, he was diagnosed with coagulation factor IX deficiency (hemophilia B). The supraorbital notch could be a passage of the SGH to extend into the subperiosteal space of the orbit.