Case ReportPosterior Fossa Epidural Hematomas: Rare but Serious Complication of 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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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.