In newborns, posterior fossa subdural hematoma (PFSDH) is a serious and rare condition, generally occurring after difficult deliveries.
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Good Results of Surgery in Newborns with PFSDH… Posterior fossa subdural hematoma is a potentially life-threatening condition in which a collection of blood (hematoma) occurs in an area at the base of the skull (posterior fossa). Pressure on the respiratory and cardiovascular centers in the brainstem can lead to serious disability or death. Less than 100 cases of PFSDH in newborns have ever been reported in the medical literature. "Excessive fetal head molding during the delivery process is the most commonly recognized cause," the researchers write.
To clarify the treatment and outcomes of this rare condition, Dr. Blauwbomme and colleagues analyzed 16 newborns with PFSDH seen at their children's hospital neurosurgery department since 1985. Most of the infants had difficult deliveries, such as use of forceps or breech birth.
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All infants were admitted to intensive care immediately after PFSDH was diagnosed. Eleven infants underwent surgery when their symptoms did not resolve with medical treatment. In most cases, surgery consisted of a careful procedure to wash out the hematoma in the posterior fossa area. In some infants, external drainage of the hematoma was possible.
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On long-term follow-up, five of the children had neurological deficits, which were severe in one case. However, the rest had relatively minor neurological abnormalities, such as partial hearing loss or problems with eye movement (oculomotor palsy).
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Because PFSDH is so rare, neurosurgeons have little experience with or information about its treatment and long-term outcomes. The new study suggests that, with appropriate evaluation and treatment—including surgery, if needed—most infants with this condition will survive with good long-term neurological functioning.
Dr. Blauwbomme and coauthors emphasize that successful treatment and good long-term outcomes are possible even in the most severely affected infants with PFSDH. They conclude, "Initial aggressive resuscitation should be performed even in cases of initial severe brainstem dysfunction because of the good long-term neurological outcome."
Source-Eurekalert
