The posterior fossa is an uncommon site for epidural hematomas. Clinical progress is silent and slow, but the deterioration is sudden and quick to become fatal if not promptly treated. Early recognition is therefore extremely important. The recommended treatment for posterior fossa epidural hematoma is surgical evacuation soon after the diagnosis, since the posterior fossa contains vital structures. However, conservative management under close clinical and radiological supervision can be applied in patients without mass effect. In our study, a review of 73 cases with posterior fossa epidural hematoma among a total number of 737 patients with epidural hematoma is presented, and a new neuroradiological classification is proposed in order to determine the appropriate type of treatment. In this series, 14 patients were treated conservatively, while 59 required surgery. The conservatively treated 9 pediatric and 5 adult patients, and 51 of the 59 surgically treated cases, in other words a total of 65 of the 73 patients, showed excellent recovery; 4 patients treated surgically had a moderate disability, and 4 patients died (overall mortality 5.4%). The critical factors influencing outcome were the neuroradiological class, the level of consciousness just before the operation, and the other systemic and/or intracranial traumatic lesions. In this study, the critical observation was that the neuroradiological findings were earlier, more reliable and predictive than the clinical findings. Therefore, based upon the obliteration of perimesencephalic cisterns and/or displacement of the fourth ventricle, a new neuroradiological classification was designed for decision-making in management.

Linear measurements of pedicle dimensions and also axial angles from horizontal and vertical planes may provide some anatomic limitations for subaxial cervical transpedicular screw fixation, and also contribute to the safety of the surgical procedure. One should also rely on tomographic data and computer-assisted guidance systems.

Approximately 5 million children present to emergency departments, seeking care for head injuries, each year, and 80% of these children are classified as cases of mild head injury. Due to the huge number of patients and low frequency of intracranial lesions in this group, obtaining a computed tomography scan for each and every patient is a significant economic problem. This study was conducted to identify the clinical parameters and the radiographic findings that may be associated with intracranial lesions in children with mild head injury. 421 patients, with a Glasgow Coma Scale score of 15 and without any focal neurological deficit, were studied. Intracranial lesion was noted in 37 cases (8.8%). Sensitivity of a plain radiogram was 43.2%, and specificity was 93%. An intracranial pathology was demonstrated in 28.9% of the patients with a linear skull fracture. The only clinical parameters associated with an increase in the frequency of detection of intracranial lesions were posttraumatic seizures and loss of consciousness. Age, sex, headache, vomiting and scalp lacerations were not associated with a higher frequency. Even when patients with a history of loss of consciousness or posttraumatic seizure were subtracted from the study group, intracranial lesions were noted in 4.1% of the cases, and in 1.8% neurosurgical intervention was required. Computed tomography is the gold standard in the evaluation of pediatric patients with mild head trauma, and every child who has experienced a head injury should undergo a cranial computed tomography evaluation, even if he or she appears in perfect health.

In transcondylar approach, the anatomical landmarks should be well known in order to make a safe occipital condyle resection. The distance between the intracranial edge of the hypoglossal canal and posterior margin of the occipital condyle is important for a safe occipital condyle resection, and it was found to be 12.55 +/-0.05 mm in our study. Approximately 12 mm occipital condyle resection can be made without giving damage to the neural tissue. This value is appropriate to the (1/2) of the occipital condyle.

Knowing the location of the venous sinuses is essential for the localization of the initial burr-hole for a retrosigmoid approach, in order to avoid inadvertent entry into the venous sinuses and limitation of the size of the bony opening. In this anatomic study, external landmarks of the posterolateral cranium have been studied, in order to reveal the relationship with the venous sinuses. Eighty-four dried adult human skulls were studied and study of both sides yielded 168 sides. Morphometric measurements of the posterolateral cranium have been performed and relations of the external landmarks with the venous sinuses have been studied. The anatomic position of the asterion was variable. The superior nuchal line was roughly parallel and below the lower margin of the sulcus of transverse sinus in all specimens. The sigmoid sinus, between the superior and inferior bends, seemed to descend along an axis defined by the junction of the squamosal-parietomastoid suture and the mastoid tip, in a slightly oblique fashion. In conclusion, a burr-hole placed just below the superior nuchal line and posterior to the axis defined by the mastoid tip and the squamosal-parietomastoid suture junction is appropriate for both avoiding inadvertent entry into the sinus and limiting the size of the craniotomy.