Treatment of a symptomatic posterior fossa subdural effusion in a child

We describe the first observation of a child with a posterior fossa subdural effusion with secondary hydrocephalus and tonsillar herniation. We diagnosed this entity in a 14-month-old girl with no history of trauma or coagulation disorder. The patient presented in our emergency department with opisthotonus and raised intracranial pressure resulting from supratentorial hydrocephalus. An emergency ventriculo-peritoneal shunt was placed, which resolved the symptoms only temporarily. Eventually external drainage of the subdural fluid was performed. The collection gradually disappeared, and both the external subdural shunt and the ventriculo-peritoneal shunt were removed. The patient made a complete neurological recovery. We review the physiopathology and treatment of subdural effusions in general, and propose some guidelines for the manage-ment of symptomatic effusions occurring in the posterior fossa in particular. Received: 18 June 1998     

Conservative management of spontaneous posterior fossa subdural hematoma in a neonate.

Symptomatic intracranial hemorrhage in term neonates is uncommon, and is usually secondary to trauma, coagulation disorders and/or hypoxia. Posterior fossa hemorrhage in the neonate is a rare neurosurgical emergency and is usually associated with the same etiological factors. Diagnosis is with computed tomography and magnetic resonance imaging. We present a spontaneous posterior fossa subdural hematoma in a term neonate and discuss conservative management.     

A spontaneous bilateral subdural effusion in an 11-year-old boy with middle cranial fossa arachnoid cyst

An 11-year-old boy gradually developed headache, vomiting and diplopia over a period of 1 month. Repeated examinations of head CT scan revealed an arachnoid cyst in the right middle cranial fossa and bilateral subdural effusion of enlarging size. Papilledema was absent on admission, but it became evident after 1 week, and lumbar puncture disclosed very high pressure (800 mmH2O) of the cerebrospinal fluid. Fenestration of the cyst to the basal cisterms quickly alleviated his symptoms of intracranial hypertension as well as the bilateral subdural effusion on CT. Macroscopically, there was a small tear on the wall of the arachnoid cyst, and it probably served as a communication valve with the subdural space. Since he had no history of head trauma in the past few months, the reason of the tear formation was unclear. Intracranial arachnoid cyst is a relatively common congenital malformation of usually benign and non-pathogenic nature. However, it may occasionally cause non-traumatic subdural effusion and intracranial hypertension.     

外伤性硬膜下积液43例临床分析

目的 探讨外伤性硬膜下积液发病机制及治疗方法 .方法 对43例患者进行回顾性分析.结果 消退型及稳定型可保守治疗,单纯钻孔引流15例,2例复发.结论 外伤性硬膜下积液单纯钻孔引流术,操作简便,效果可靠.     

外伤性硬膜下积液术后复发3例分析

外伤性硬膜下积液(traumatic subdural effusion,TSE),最早由Mayo于1894年报告,多在伤后数小时至1周发生,1个月达最大量。早期一般观察治疗,若积液增多且引起颅高压症状,则采取手术治疗。现就我院3例术后复发患者进行分析,以加深对此病的认识。     

An infant with an intradural lipoma of the cervical spine extending into the posterior fossa.

BACKGROUND: Intradural lipomas of the cervical spine are very rare. These tumours show no association with spinal dysraphism. We describe an infant with cervical spinal cord lipoma. Surgical decompression of the cord resolved all neurologic deficits. CASE DESCRIPTION: An 8 month old female infant presented with retarded development of motor function in the limbs, in addition to dysphagia. Computed tomography identified a tumour of fat density that extended from the medulla to C7. Magnetic resonance imaging showed hyperintensity on both T1- and T2-weighted images. A fat-suppression sequence demonstrated an area of signal enhancement in the dorsal portion of the tumour following administration of gadolinium. The adjacent spinal cord was normal. Partial removal of the tumour was performed together with decompressive laminoplasty. The enhancing region proved to be fibrous tissue. Motor development resumed in the week following operation. CONCLUSION: Retarded motor development was the main manifestation of this infant's rare spinal tumour. Neuroimaging was of considerable diagnostic value; in particular, fat-suppression magnetic resonance imaging demonstrated details of the tumour and surrounding structures. Decompressive laminoplasty and laminectomy with partial removal of the tumour was effective in reversing clinical deficits.     

Mutism after evacuation of acute subdural hematoma of the posterior fossa

Case report A 7-year-old boy was involved in a road traffic accident. A computed tomography scan revealed an acute subdural hematoma (ASDH) of the posterior fossa, traumatic subarachnoid hemorrhage, and distortion of the brain stem. Removal of the ASDH was completed 3.5 h after injury. After extubation, the patient rapidly recovered consciousness. He was able to follow commands, although he did not speak. He began to utter 14 days after the injury. His speech became normal 39 days after injury. A magnetic resonance imaging scan revealed a post-contusional change in the right cerebellum and an ischemic lesion in the pons.Discussion Immediate removal of the hematoma is the only therapy for patients with ASDH of the posterior fossa. Although any lesions of the dentate nucleus, red nucleus, thalamus, cerebral cortex, and pons, all of which are involved in this case, are able to cause mutism, his mutism was primarily caused by the severe ASDH of the posterior fossa. The transient nature of this syndrome suggests that the cause of the mutism is trauma-related edema and/or transient ischemia of these structures.     

儿童创伤性颅后窝硬脑膜外血肿的治疗

目的总结儿童创伤性颅后窝硬脑膜外血肿(PFEDH)的临床特点和诊治经验。方法回顾性分析30例经手术和(或)影像学检查确诊的儿童创伤性PFEDH的临床资料,其中车祸伤18例,坠落伤9例,跌伤3例;均有枕部着力伤。GCS评分:8～10分3例,11～12分9例,13～14分18例。根据血肿量和病人情况,采用非手术治疗或手术治疗。结果非手术治疗6例,伤后3个月复查CT血肿均完全吸收,神经系统检查未见明显异常;手术治疗24例,术后所有病儿病情平稳好转,头痛症状逐渐消失,术后CT显示血肿基本清除。本组无手术相关并发症。出院时病儿按GOS预后分级均恢复良好。结论枕部着力伴局部颅骨骨折的病儿发生PFEDH的风险大,如能早期诊断并及时处理,儿童创伤性PFEDH可获得良好疗效。     

小儿创伤性硬膜下积液的临床诊断与治疗

硬脑膜下腔积液(subdural effusion)是临床常见的疾病,病因多样,主要有颅脑外伤、颅脑手术后并发症、蛛网膜囊肿破裂、颅内感染、免疫疾病等.婴幼儿颅脑外伤后,易好发硬脑膜下腔积液,治疗不及时可影响脑发育.硬脑膜下腔积液演变有一定规律,不同时期治疗原则不同.我们通过回顾分析我院小儿神经外科病房29例住院患者的临床经过,总结诊断和治疗经验.     

Giant arteriovenous aneurysm of the posterior fossa in a three-month-old infant

A 3-month-old female infant presented a 20-day history of drowsiness and maturing deterioration. The neurological exam showed peripheric facial palsy on the right side and a brachiocrural hemiparesis on the left. A brain scan revealed a lesion of avascular content in the posterior fossa. The computed tomography scan showed hydrocephalus and a high-density lesion, nonenhanced after introduction of the contrast agent, compatible with a clot at posterior fossa level. Likewise, after contrast new images appeared which had not been seen previously, considered as afferent and efferent vascular elements to the lesion. The cerebral angiography showed an avascular lesion in the cerebellar vermis with important hypertrophy of arterial and venous elements, although no steal phenomena of neighbouring areas was evident. These findings, and the absence of cardiac failure, suggested the diagnosis, confirmed by surgery, of giant clotted arteriovenous malformation. The patient has done well postoperatively.     

外伤性后颅窝硬膜外血肿的诊断和治疗

后颅窝硬膜外血肿(posterior fossa extradural hematoma,PFEDH)较幕上血肿少见,却是最常见的外伤性后颅窝占位病变,并常导致严重并发症。临床上,其症状隐匿,发展相对缓慢,但另一方面,病情变化快而突然,若不及时处理,常是致命性的[1,2]。现就我院1996年1月￣2005年12月收治的43     

Hemorrhagic subdural effusion complicating an endoscopic III ventriculostomy

Subdural effusion, a common postoperative complication of extracranial shunting for hydrocephalus, is usually caused by excessive drainage of cerebrospinal fluid. Subdural effusion is thought to occur less frequently after a neuroendoscopic III ventriculostomy, and no reported cases have been symptomatic. We encountered a symptomatic subdural effusion with a component of hemorrhage 5 days after the latter procedure was performed to treat massive hydrocephalus in a 2-year-old boy. Received: 21 September 1998 Revised: 20 July 1999     

Orthostatic tremor arises from an oscillator in the posterior fossa.

We tested the hypotheses that orthostatic tremor is generated by a central oscillator and that the tremor is expressed through spinal Ib interneurons. Six patients with orthostatic tremor were examined. The tremor was reset by electrical stimulation over the posterior fossa at intensities that were below the threshold for a motor evoked potential (MEP) but was not reset by transcranial magnetic stimulation over the motor cortex that did produce an MEP. It is argued that the oscillator involves the cerebellum or brainstem. The inhibition of voluntary EMG produced by stimulation over tendons, which has been attributed to effects from Golgi tendon organs (GTO), was not modulated in synchrony with the tremor. We were unable to demonstrate, therefore, that the tremor is expressed through GTO interneurons with this method.     

Acute subdural effusion in vasculitis

We report a 29-year-old man with a unique presentation of vasculitis as acute unilateral subdural effusion and meningoencephalitis. Magnetic resonance imaging showed a brainstem lesion that spread to the thalamus over time. There were no systemic features of vasculitis other than a positive pathergy test. Histopathological examination from the pathergy site showed neutrophilic infiltrate and leucocytoclastic vasculitis. The condition was steroid responsive and he remained in remission at two years' follow-up. The anatomy of the brainstem lesion, absence of other inflammatory and infective conditions on evaluation suggests a vasculitic pathology either as primary central nervous system angiitis or as neurological presentation of systemic vasculitis like Behetaet's disease although the international diagnostic criteria for Behetaet's were not fulfilled.     

外伤性硬膜下积液在向慢性硬膜下血肿转化过程中的相关因素配对回归分析

目的 回顾性研究外伤性硬膜下积液向慢性硬膜下血肿(CSDH)转化过程中相关因素的影响.方法 对22例慢性硬膜下血肿中明确有外伤性硬膜下积液(TSE)的患者根据性别、年龄、职业配对单纯外伤性硬膜下积液的患者(1∶2配对,共44例).多因素回归分析外伤性硬膜下积液转化为慢性硬膜下血肿组与单纯外伤性硬膜下积液组间在硬膜下积液CT值、积液部位、积液体积、凝血功能4种相关因素间有无差异.结果 外伤性硬膜下积液转化为慢性硬膜下血肿组与单纯外伤性硬膜下积液组间患者的伤后硬膜下积液CT值、积液部位间差异存在统计学意义.结论 外伤性硬膜下积液存在向慢性硬膜下血肿转化的趋势,患者硬膜下积液的CT值相对较高、积液位于额颞部患者这一趋势尤为明显.     

Posterior fossa subdural hematomas in neonates

Posterior fossa subdural hematomas in the newborn infant are rare but potentially treatable. The infants are normal after birth, but within days, hydrocephalus hypotonia, and irregular respirations develop. Seizures and third nerve pareses are unusual. We report a neonate in whom this process was identified by computerized tomographic brain scan. We also discuss potential misinterpretations of the computerized tomographic brain scan in neonates.     

创伤性后颅窝血肿的临床特点及救治体会

目的 探讨创伤性后颅窝血肿的临床特点及救治方法。方法 对我科2000-01～2005-06期间收治的创伤性后颅窝血肿忠者51例的临床资料进行分析，根据后颅窝血肿的病情及出血量的多少而采取保守治疗或手术治疗。结果 51例患者中，保守治疗12例，恢复良好11例，死亡1例；手术治疗39例，恢复良好31例，伤残4例，死亡4例。结论 创伤性后颅窝血肿有着不同于幕上创伤性颅内血肿的临床特点，意识障碍较轻，小脑受顿的特异性症状如眼球水平震颤、共济失调等较少见，而头痛、呕吐、躁动不安等非特异性症状较多见，易直接发生枕骨大孔疝。严密观察及动态CT检查，及时抓住手术时机，可有效降低致残率及死亡率。