Single burr hole evacuation for traumatic acute subdural hematoma of the posterior fossa in the emergency room.

A 57-year-old man and a 55-year-old man presented with acute subdural hematoma of the posterior cranial fossa due to trauma. Both were comatose preoperatively. Emergent single burr hole evacuation in the posterior cranial fossa was performed in the emergency room immediately after computed tomography. Neurological symptoms improved dramatically just after initiating the burr hole evacuation in both patients. A 57-year-old man became alert and could walk unassisted 1 month after surgery. The other could walk with assistance 4 months after surgery, although psychic disturbance resulting from cerebral contusion remained. Single burr hole evacuation in the emergency room is a useful treatment for acute subdural hematoma of the posterior cranial fossa because the procedure can be performed easily and rapidly, thus achieving reduction of intracranial pressure. Progressing neurological deterioration, reversibility of brainstem function by mannitol administration and the sign of brainstem compression and noncommunicating hydrocephalus are good indicators for this treatment.

[1]  Brahm Goldstein,et al.  Consultation with the specialist: increased intracranial pressure. , 1999, Pediatrics in review.

[2]  L. Pitts,et al.  Functional recovery after traumatic transtentorial herniation. , 1991, Neurosurgery.

[3]  G. Cybulski,et al.  Hematoma in the posterior fossa secondary to a tangential gunshot wound of the occiput: case report and discussion. , 1991, Neurosurgery.

[4]  T. Hamasaki,et al.  [Traumatic posterior fossa hematoma]. , 1987, No to shinkei = Brain and nerve.

[5]  L. Pitts,et al.  Is computed tomographic scanning necessary in patients with tentorial herniation? Results of immediate surgical exploration without computed tomography in 100 patients. , 1986, Neurosurgery.

[6]  B. N. French,et al.  Traumatic hematomas of the posterior fossa. A clinicopathological spectrum. , 1986, Surgical neurology.

[7]  H. A. Young,et al.  Complications accompanying occipital skull fracture. , 1982, The Journal of trauma.

[8]  J. Miller,et al.  Reversible brain-stem dysfunction following acute traumatic subdural hematoma: a clinical and electrophysiological study. , 1981, Journal of neurosurgery.

[9]  J. Clinton,et al.  Emergency twist drill trephination. , 1981, Neurosurgery.

[10]  J. Huprich,et al.  Computed Tomography of Posterior Fossa Trauma , 1980, Journal of computer assisted tomography.

[11]  Sokolowski Jh,et al.  Traumatic intracerebellar haematoma. , 1978 .

[12]  H. Kohno,et al.  Diagnostic Problems of Acute Posterior Fossa Hematoma , 1976 .

[13]  J. Miles,et al.  Posterior fossa subdural haematomas , 1974, Journal of neurology, neurosurgery, and psychiatry.

[14]  K G Jamieson,et al.  Surgically treated traumatic subdural hematomas. , 1972, Journal of neurosurgery.

[15]  C. Arseni,et al.  Traumatic cerebellar haematoma associated with posterior cerebral fossa subdural haematoma. , 1972, Psychiatria, neurologia, neurochirurgia.

[16]  R. Wright.  Traumatic hematomas of the posterior cranial fossa. , 1966, Journal of neurosurgery.

[17]  J. Ciembroniewicz.  Subdural hematoma of the posterior fossa. Review of the literature with addition of three cases. , 1965, Journal of neurosurgery.

[18]  R. Smith,et al.  Acute subdural hemorrhage of posterior fossa. Report of a case with review of the literature. , 1961, Journal of neurosurgery.