The Management of Birth-Related Posterior Fossa Hematomas in Neonates

Abstract

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.

Neurological Outcome in a Term Infant with Tentorial Laceration Leading to Subdural Haemorrhage Following Vacuum-Assisted Delivery: A Case Report and Literature Review

“…Volpe inferred in an article that slow-reacting or unreactive pupils due to compression of the occulomotor nerve are the most distinctive sign of posterior fossa [12]. Apnoea or seizures were the two most common presentation in a series and such symptoms following vacuum extraction should raise suspicion [15] as seen in our case. In Huang et al case series, heavily blood-stained CSF was found in all 6 cases in whom lumbar puncture was possible [13].…”

“…Risk factors for developing SDH in general are outlined in Table 1 [12]. Clues in the neonate can be highly variable and include any number or combination of the following; bulging fontanellae, increased occipito-frontal circumference, apnoea, bradycardia, respiratory distress, retinal haemorrhage, lethargy, fever, opisthotonus and seizures [14,15]. Volpe inferred in an article that slow-reacting or unreactive pupils due to compression of the occulomotor nerve are the most distinctive sign of posterior fossa [12].…”

“…Blauwblomme et al. Concluded that MRI in the acute setting did not infl uence their decision for surgery but suggested that later scans may help with the prognosis [15].…”

“…Tentorial laceration is the most commonly reported injury seen in vacuum extraction due its anatomy vulnerable to vertical traction forces. The vertical parts of the tentorium cerebelli (running up beside the straight sinus, later fusing to becoming the falx cerebri) is under the greatest strain when the foetal head is forced to assume brachycephalic and turricephalic shapes during labour [15,18]. This transient moulding of the head shape also causes stretching of the internal cerebral veins, basal veins of Rosenthal, the vein of Galen, the infratentorial veins, lateral and straight sinuses [12,15].…”

“…The vertical parts of the tentorium cerebelli (running up beside the straight sinus, later fusing to becoming the falx cerebri) is under the greatest strain when the foetal head is forced to assume brachycephalic and turricephalic shapes during labour [15,18]. This transient moulding of the head shape also causes stretching of the internal cerebral veins, basal veins of Rosenthal, the vein of Galen, the infratentorial veins, lateral and straight sinuses [12,15]. The vein of Galen appears to be even less adaptable to the vertical shear force as its distal end is attached to the dura at the straight sinus whilst its proximal is relatively free to move [15,18].…”