Child's Nerv Syst (1996) 12: 145-148 9 Springer-Verlag 1996 J. M. Costa Clara E. Claramunt L. Ley J. Lafuente Traumatic extradural hematomas of the posterior fossa in children Received: 12 January 1995 Revised: 10 September 1995 J. M. Costa Clara ([]) - E. Claramunt L. Ley 9 J. Lafuente Neurosurgery Department, University Hospital Sant Joan de Deu, Crta. de Esplugas s/n, E-08034 Barcelona, Spain Fax: 203 39 59 Abstract The most favorable type of traumatic intracranial bleeding in childhood is the extradural hemor- rage (EDH). The posterior fossa lo- cation is less frequent than the supra- tentorial site. In the period from Jan- uary 1989 to January 1994 we treated 2,372 patients with craniocer- ebral trauma; 31 had extradural he- matomas (1.3%); 3 of them were lo- cated in the posterior fossa (9.7%): 1 boy and 2 girls aged from 6 to 16 years. The traumatic mechanism was an occipital fall in all cases. Diagnosis was made by computed tomography scan (CT). Two of them had a rapidly deteriorating course. The three patients were operated on without mortality and there was no morbidity. The role of CT in the early detection of lesions and prompt surgical evacuation may reduce the mortality and morbidity from this le- sion. The interaction between these factors is discussed. Key words Head trauma 9 Epidural hematoma 9 Posterior fossa 9 Hematoma evacuation Introduction Extradural hemorrhage (EDH) has been recognized as an emergent entity since Hutchinson's review in 1867 [11]. According to some authors, EDH complicates from 1.14% to 5.8% of all head injuries [9, 10]. EDH, a common complication of head injury, is rare in children and can be fatal if not treated expeditiously; early diagnosis is essential if the treatment is to be effective [4, 6, 12, 16, 18]. Availability of computed tomography (CT) accounts for the present mortality of 9.4% when compared with the mortality of 33% for conventional diagnostic fa- cilities [2, 6]. The incidence of PFEHs among intracranial EDH has been reported to be 3.4-15% [1, 5, 12, 17, 19]. Traditionally, the management of EDH consists of sur- gical evacuation of the clot, although recent reports have suggested that small EDH can be managed conservatively in selected cases [12, 14]. A review of the literature reveals that the majority of patients with PFEHs initially present with mild symptoms, which then progress slowly and can be misleading until the terminal stage [1, 7, 9, 13]. In the period from January 1989 to January 1994 we treated 2,372 patients with craniocerebral trauma; 31 had EDH (1.3%); 3 of them (9.7%) were located in the poste- rior fossa. We present these 3 cases, emphasizing the role of CT in early detection of the lesion when the clinical symptoms are mild [3, 5, 15]. Case reports Case 1 This 6-year-old boy entered the emergency room on 13 January 1994. Two hours earlier he had tripped and fallen at home, striking the oc- ciput. He did not lose consciousness then, but he was somnolent thereafter, and vomiting and headache ensued. The findings of phys- ical and neurological examinations were normal. Although somno- lent, the patient responded to verbal commands. Skull X-ray films revealed a linear fracture of the middle occipital bone. A computed tomography (CT) scan showed a occipital fracture (Fig. l) and a biconvex, mixed hyper- and hypodense area on the right side of the posterior fossa, without mass effect (Fig. 2). The child became progressively more stuporous with disturbances of car-