CLINICAL ARTICLE J Neurosurg Pediatr 21:38–43, 2018 S pontaneouS intracranial hematoma is an unusual complication of primary and secondary coagulation diatheses in children. 7,22 Management of these cases is a challenge when the patients present with acute neu- rological deterioration. However, with prompt diagnosis and an appropriate hematological treatment plan, a good neurological outcome may be achieved. A combined ap- proach is necessary for 1) rapid access to neuroimaging for prompt radiological diagnosis, 2) correction of any coagu- lation abnormalities (including perioperative correction), and 3) immediate neurosurgical management of the hema- toma, if required. The pediatric neurosurgical service in Dublin provides surgical care for all pediatric neurosurgical patients re- ferred within the Irish Republic. We performed a retro- spective review of cases involving children with intracra- nial hematomas who required neurosurgical operations and examined the similarities of the cases. Methods We used the available pediatric database to identify all cases in which patients required a craniotomy for treat- ment of intracranial hematoma in the Temple Street Chil- dren’s Hospital and pediatric neurosurgical service in Beaumont Hospital during the 5-year period from 2008 to 2012. This study was a retrospective analysis of data that were collected as part of routine diagnosis and treat- ABBREVIATIONS aPTT = activated partial thromboplastin time; GCS = Glasgow Coma Scale; GOS-E Peds = Pediatric Glasgow Outcome Scale–Extended; ICH = intrace- rebral hematoma; ITP = idiopathic thrombocytopenic purpura; rFVIIa = recombinant activated factor VII; PT = prothrombin time; SDH = subdural hematoma. SUBMITTED October 7, 2016. ACCEPTED June 1, 2017. INCLUDE WHEN CITING Published online November 10, 2017; DOI: 10.3171/2017.6.PEDS16574. Neurosurgical management in children with bleeding diathesis: auditing neurological outcome Zaitun Zakaria, PhD, Chandrasekaran Kaliaperumal, FRCSI, FRCSEd(NeuroSurg), Darach Crimmins, FRCS, and John Caird, FRCSI(SN) Department of Paediatric Neurosurgery, Temple Street Children’s University Hospital, Dublin, Ireland OBJECTIVE The aim of this study was to assess the outcome of neurosurgical treatment in children with bleeding di- athesis and also to evaluate the current management plan applied in the authors’ service. METHODS The authors retrospectively analyzed all cases in which neurosurgical procedures were performed in pedi- atric patients presenting with intracranial hematoma due to an underlying bleeding tendency over a 5-year period at their institution. They evaluated the patients’ neurological symptoms from the initial referral, hematological abnormalities, sur- gical treatment, neurological outcome, and scores on the Pediatric Glasgow Outcome Scale–Extended (GOS-E Peds) obtained 1 year after the last operation. RESULTS Five patients with a bleeding diathesis who underwent surgery for intracranial hematoma were identifed; the diagnosis was hemophilia A in 3 cases, idiopathic thrombocytopenic purpura in 1 case, and severe aplastic anemia in 1 case. Intracerebral hematoma (ICH) (n = 4) and acute subdural hematoma (n = 1) were confrmed on radiological inves- tigations. In 2 of the 4 patients with ICH, the diagnosis of bleeding diathesis was made for the frst time on presentation. Four patients (all male) were younger than 2 years; the patient with severe aplastic anemia and spontaneous ICH was 15 years old and female. The duration of symptoms varied from 24 hours to 5 days. Neurological examination at 1 year’s follow-up showed complete recovery (GOS-E Peds score of 1) in 3 cases and mild weakness (GOS-E Peds score of 2) in 2 cases. CONCLUSIONS Neurosurgical management of patients with bleeding diathesis should be carried out in a tertiary-care setting with multidisciplinary team management, including members with expertise in neuroimaging and hematology, in addition to neurosurgery. Early diagnosis and prompt treatment of a bleeding diathesis is crucial for full neurological recovery. https://thejns.org/doi/abs/10.3171/2017.6.PEDS16574 KEY WORDS bleeding diathesis; hemophilia A; idiopathic thrombocytopenic purpura; intracerebral hematoma; subdural hematoma; aplastic anemia; trauma J Neurosurg Pediatr Volume 21 • January 2018 38 ©AANS 2018, except where prohibited by US copyright law Unauthenticated | Downloaded 02/21/22 12:21 PM UTC