MANAGEMENT OF EPIDURAL HEMATOMAS OF THE TOMAS OF THE TOMAS OF THE TOMAS OF THE TOMAS OF THE POSTERIOR CRANIAL FOSSA

Objective: To present our experience in the management of posterior fossa epidural hematoma (PFEDH).
Materials and Methods: This descriptive study was conducted in Head injury unit Hayatabad Medical Complex,
Peshawar, from October 2006 to October 2009. All patients with PFEDH from all ages and both sexes were included.
However supratentorial extradural hematoma, PFEDH due to bleeding disorders or post operative PFEDH were
excluded from the study. All patients were evaluated regarding age, gender, and mechanism of trauma, presentation
and Glasgow coma score by the time of admission. Diagnosis was established in with CT scanning .Treatment was
either surgical or conservative in selected cases. Patients were followed for one month after surgery. Treatment
outcome was considered favorable if GCS was more than 8 and unfavorable if GCS was 8 or below.
Results: Total twenty two patients were studied. Eighteen (81.81%) were male and 4 (18.18%) were female patients.
Male to female ratio was 4.5:1 Ages of the patients ranged from 5-60 years. Mean age (± standard deviation) was
29.2 ± 22.3 years. Commonest presentations were vomiting fallowed by altered consciousness. Fifteen patients
(68.18%) had vomiting while twelve patients (54.55%) had altered level of consciousness. GCS ranged between 4
and 15 at presentation. The lowest GCS was E1M2V1.This patient expired one hour after surgery. Nine patients
(40.9%) had no other intracranial associated lesions. The rest had other skull or intracranial pathologies as well.
Nineteen cases (86.36%) with epidural hematoma were operated based on clinical and radiological evaluation.
Three patients (13.64%) were conservatively treated. One patient (4.55%) died just after admission. This patient had
large extradural hematoma in the posterior fossa and brain stem herniation was already occurred. Eighteen patients
(81.8%) had favorable while three patients (13.63%) had unfavorable outcome after one month fallow up.
Conclusion: Although posterior fossa is not a common site for EDH, it can be fatal if missed. The clinical picture is
variable but strong clinical suspicion is needed. CT Scan brain should be immediately done if there is even little
doubt of PFEDH. Posterior fossa creniectomy has got good results. Those cases which are being treated conservatively
should be carefully monitored. Mortality and morbidity can be decreased in PFEDHs if they are diagnosed earlier
and promptly treated
Key words: Epidural hematoma. Posterior cranial fossa, Management