Fatal Distant Venous Epidural Hematoma Following Posterior Cranial Fossa Surgery in a Twelve-Year old Child

Abstract

Cranial epidural hematoma is a serious event requiring immediate intervention. This can be due to sudden traction tearing the vessels between the dura and the skull. During posterior fossa surgery, brain collapse may emerge due to the sudden reduction of prolonged elevated intracranial pressure; it could cause dura-skull detachment to create epidural hematoma even far from the surgical site. Hence, we should be aware of this complication when approaching posterior fossa tumors as it frequently leads to severe neurologic impairment or death. Here, we report a 12-year old previously healthy child who was admitted with a 4-month history of severe headache, vomiting, and right eye blindness due to increased intracranial pressure. A brain Computed Tomography (CT) scan showed obstructive hydrocephalus, and contrast-enhanced Magnetic Resonance Imaging (MRI) confirmed intraventricular posterior fossa tumor. After tumor resection, the patient developed an epidural hematoma far from the surgery site. Removal of the hematoma exposed lacerations of superior sagittal sinus due to dural detachment. Failure to control intracranial pressure resulted in a fatal outcome.

Intracranial epidural hematoma after use of a 3-pin head clamp in a pediatric case with posterior fossa tumor and hydrocephalus: A case report

“…Although there are many anatomical trick points during the application, some complications can be seen during or after insertion. The most important of these is intracranial hemorrhage [1,2]. We report a case that developed an epidural hematoma after the use of a head clamp system, which is rarely reported in the literature.…”