The Management of Birth-Related Posterior Fossa Hematomas in Neonates

Blauwblomme, Thomas MD*,‡; Garnett, Matthew MD§; Vergnaud, Estelle MD; Boddaert, Nathalie MD; Bourgeois, Marie MD*,‡; DiRocco, Federico MD*,‡; Zerah, Michel MD*,‡; Sainte-Rose, Christian MD*,‡; Puget, Stéphanie MD, PhD*,‡

doi: 10.1227/NEU.0b013e318286fc3a
Research-Human-Clinical Studies
Press Release

BACKGROUND: Symptomatic posterior fossa hematoma in the term newborn is rare.

OBJECTIVE: To report on the management and outcome of posterior fossa subdural hematoma (PFSDH) in neonates.

METHODS: A retrospective analysis of the department database and clinical notes of neonates admitted since 1985 with a PFSDH was performed together with a literature review of similar case series.

RESULTS: Sixteen patients were included. The median gestational age was 40 weeks with a high proportion of primiparous mothers (n = 9) and forceps delivery (n = 9). Nine neonates had symptoms of brainstem dysfunction within the first 24 hours of life, whereas the other 7 had a delayed presentation (median 4 days) with signs of raised intracranial pressure due to hydrocephalus. Each patient had a cranial ultrasound followed by computed tomography scan that showed the PFSDH. Eleven neonates required surgical evacuation of the PFSDH, whereas hydrocephalus was managed by transient external ventricular drainage in 2 further patients. Eventually, 2 neonates required a permanent ventriculoperitoneal shunt. Five neonates had no operative intervention. With a mean follow-up of 7.8 years, 2 patients had mild developmental delay and 1 had severe developmental delay. The 13 other patients had a normal development.

CONCLUSION: In neonates with a PFSDH, surgery can be safely performed in those who have clinical and radiological signs of brainstem compression or hydrocephalus. A small number of neonates require a ventriculoperitoneal shunt in the long term. Initial aggressive resuscitation should be performed even in cases of initial severe brainstem dysfunction because of the good long-term neurological outcome.

ABBREVIATIONS: PFSDH, posterior fossa subdural hematoma

VP, ventriculoperitoneal

*AP-HP, Hôpital Necker Enfants Malades, Department of Pediatric Neurosurgery, Paris, France;

Université Paris Descartes, Sorbonne Paris Cité, France;

§Department of Neurosurgery, Addenbrookes Hospital, Cambridge, United Kingdom;

AP-HP, Hôpital Necker Enfants Malades, Department of anesthesiology, Paris, France;

AP-HP, Hôpital Necker Enfants Malades, Department of Radiology, Paris, France

Correspondence: Thomas Blauwblomme, MD, Service de Neurochirurgie Pédiatrique, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France. E-mail: thomas.blauwblomme@nck.aphp.fr

Received June 21, 2012

Accepted December 25, 2012

Copyright © by the Congress of Neurological Surgeons