Isolated Traumatic Posterior Fossa Epidural Hematomas In Children:An Analysis Of 38 Cases

Objective: To investigate the clinical features,imaging findings and surgical indications of isolated traumatic posterior fossa epidural hematomas in children,some basis strategies for clinical diagnosis and treatment of PFEDH in pediatric may be provided according to this research.Methods: A retrospective review was conducted on 38 children with isolated traumatic posterior fossa epidural hematomas admitted to our Department of Neurosurgery from July 2015 to December 2017.To find the characteristics and relationships with disease,different indices like age,admission time,cause of injury,clinical features,imaging findings,treatment,et al,were analyzed.Results: All 38 patients were analyzed.Among them,33(86.8%)patients were above 3-year-old and 17(44.7%)patients got injured by slipping.The time patients got admitted was 4 hours~5 days.The mainly clinical features,included nausea,vomiting,headache,energielos,were usually atypical and without conscious disturbance.The CT imaging suggested that the hematomas of 32 patients(84.2%)got liquified easily in acute stage(84.2%).The hematoma volume of 18 patients(47.4%)were in the10-20 mL group,the hematoma thickness of 20 patients(52.6%)were >15mm.The CT value of high density region was significantly higher than the low density region[(71.7±4.4)Hu vs(42.6±3.8)Hu,P<0.01].There was no statistical significance between the evenly high density hematoma group and the mix density hematoma group in pair comparison and hematoma states comparison(P>0.05).24 cases received surgical treatment,8 of them occurred acute clinical deteriorated during conservation treatment.14 cases treated with the conservation management.There was no statistical significance between the surgical treatment group and the conservation management group in pair comparison of age,gender,admitted time,hematoma location,density of hematoma and combined injury(P>0.05).The hematoma volume and thickness were significantly higher than the conservation management group[(18.0±9.1)mL vs(5.8±2.8)mL,(18.1±3.7)mm vs(9.8±3.2)mm;P<0.01,P<0.01].The patient whom with the hematoma volume≥10mL,the hematoma thickness≥15mm,obviously mass effect,or the hematoma increase progressively during conservation treatment,had a higher risk to get surgery(P<0.05).Thickness of hematoma was independent risk factor for surgical treatment(OR=1.77,95%CI:1.248~2.51,P=0.001).The thicker the hematoma thickness was,the higher possibility the patient get surgical treatment.All cases were followed up for 3 months to 2 years.All children recovered well without death and disability.Conclusion: The children in pre-school age and school age have a higher morbidity.Most patients got injured by slipping.The mainly clinical features were usually atypical and without specificity.The CT imaging suggested that the hematomas got liquified easily in acute stage with the mechanism is not clear.When one of the followed occasion exist,the volume of hematoma ≥ 10 mL,the thickness of hematoma ≥ 15 mm,obviously mass effect,the hematoma increase progressively during conservation treatment,a positive and in time surgical treatment should be taken immediately.Thickness of hematoma was independent risk factor for surgical treatment.Grasping the operation indications properly is the key to achieve a good result.