Elsevier

World Neurosurgery

Volume 115, July 2018, Pages 105-109
World Neurosurgery

Case Report
Posterior Fossa Epidural Hematomas: Rare but Serious Complication of Occipitocervical Fusion Surgery

https://doi.org/10.1016/j.wneu.2018.04.069Get rights and content

Highlights

  • 1.

    Posterior fossa epidural hematoma is a rare complication of occipitocervical fusion surgery. Once it happens, it is serious and can lead to death.

  • 2.

    It is important for surgeons to realize that posterior fossa epidural hematomas may occur after occipitocervical fusion surgery.

Background

Posterior occipitocervical fusion surgery is a commonly used surgical method to treat various craniovertebral junction pathologies. Though it is an effective method, there also have been some reports about complications of occipitocervical fusion. However, there have been no reports about posterior fossa epidural hematomas after occipitocervical fusion.

Case Description

A 44-year-old female was referred to our hospital with a 6-month history of neck pain and numb limbs for 2 months. On the basis of the imaging findings of the patient, the diagnosis was basilar invagination with atlantoaxial dislocation associated with Klippel-Feil syndrome and O-C1 assimilation. According to the principle of treatment, occipitocervical fusion surgery was performed. The operation was completed successfully, and the patient awoke from anesthesia 10 minutes later and went back to the orthopedic intensive care ward. Twenty hours after surgery, her mental status had deteriorated to a stupor, and both her pupils had dilated to 5 mm. Acute posterior fossa epidural hematomas were revealed by emergent computed tomography of the brain. Emergency craniectomy decompression and epidural hematoma removal surgery were performed for her in a timely manner. However, her mental status still did not improve and she fell into a deep coma. Her pupillary reflex disappeared, and then she died.

Conclusions

Posterior fossa epidural hematoma is a rare complication of occipitocervical fusion surgery. Once it happens, it can be serious and even lead to death. It is important for the surgeons to realize that posterior fossa epidural hematomas may occur after the occipitocervical fusion surgery.

Introduction

Posterior occipitocervical fusion surgery is a commonly used surgical method to treat various craniovertebral junction pathologies (i.e., traumatic, congenital, degenerative, inflammatory, neoplastic). Basilar invagination and instability at the occipitoatlantoaxis region are the most common indications for the surgery.1, 2, 3, 4 Though it is an effective method, there have also been reports about complications of occipitocervical fusion.5, 6, 7 However, to our knowledge, there have been no reports about posterior fossa epidural hematomas after occipitocervical fusion. We report a case of posterior fossa epidural hematomas after the occipitocervical fusion to summarize and share our experience and lessons learned.

Section snippets

Case Report

A 44-year-old female was referred to our hospital with a 6-month history of neck pain and numb limbs for 2 months. She had physiotherapy for 3 weeks in other medical institutions before she came to our spine department, but her symptoms gradually got worse. The patient denied bleeding disorders and pain in other sites and could not recall any recent injury. Medical history was unremarkable for inflammation or trauma of the cervical spine. Physical examination displayed a decreased range of

Discussion

Posterior fossa epidural hematoma is uncommon, as it only accounts for 1.2%−15% of all epidural hematomas, with a slightly higher incidence in children as compared with other age groups.8, 9, 10, 11 Common causes of posterior fossa hematoma are trauma and complications from decompression craniectomy at the posterior fossa. The reasons for the formation of posterior fossa hematoma include traumatic transverse sinuses, dural blood vessels, and platelet hemorrhage due to skull fractures. Early

Conclusions

Posterior fossa epidural hematoma is a rare complication of occipitocervical fusion surgery, but it is serious once it happens, even leading a patient to die. It is important for surgeons to realize that posterior fossa epidural hematomas may occur after occipitocervical fusion surgery. Once patients have a chief complaint such as head pain or vomiting, we must notice the patient's condition improving. Emergency CT scan of the brain is the best method to find an abnormal complication, and

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Cited by (6)

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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