Management and outcomes of posterior fossa subdural hematomas in neonates
Management and outcomes of posterior fossa subdural hematomas in neonates
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DOI：
10.1097/00006123-199706000-00016
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发表时间：
1997-06-01
期刊：
影响因子：
4.8
通讯作者：
Humphreys, RP
中科院分区：
文献类型：
--
作者：
Perrin, RG;Rutka, JT;Humphreys, RP
目的：回顾和分析在计算机断层扫描和磁共振成像时代治疗的15例新生儿后颅窝硬膜下血肿（PFSDHs）。方法：回顾性回顾所有患有PFSDHs的新生儿，并对其进行神经外科会诊以制定治疗计划。结果：男性9例，女性6例。平均胎龄为39周。患者的15位母亲中有9位是初产妇。7例患者采用器械辅助分娩（产钳和/或真空抽吸器）。婴儿平均出生体重为3165 g（范围为2160-3930 g）。平均阿普加评分为7.5分。13名新生儿在出生后24小时内出现PFSDH症状。主要的症状和体征是发育不全、易怒、癫痫发作、呼吸暂停和心动过缓。腰椎穿刺排除中枢神经系统败血症进行了六个新生儿。血象显示6例新生儿贫血伴低血红蛋白，5例低血小板，4例诊断时凝血酶原和/或部分凝血活酶时间异常。计算机断层扫描确定了所有病例PFSDH的诊断。对2例新生儿进行磁共振成像。通过影像学检查诊断的中位时间是出生后10小时。对8名新生儿进行了PFSDHs的手术清除。对7名新生儿进行保守的连续影像学检查。两组均无死亡病例。随访时间为2 ~ 10年，平均4.5年。功能结果评估显示，7例新生儿神经发育正常，3例轻度发育迟缓，2例中度发育迟缓，3例重度发育迟缓。除了pfsdh的外伤性原因外，3名新生儿在出生时观察到凝血障碍，1名在随访中观察到后窝髓母细胞瘤在出生时出血。结论：PFSDHs是一种罕见但重要的新生儿早期诊断病变。如果对脑干功能障碍的体征和症状及时进行手术，可以挽救生命。寻找诱发PFSDH的潜在原因，有时可能会发现凝血障碍或肿瘤，需要额外的治疗考虑。
OBJECTIVE: To review and analyze a contemporary series of 15 neonates who were treated for posterior fossa subdural hematomas (PFSDHs) during the era of computed tomography and magnetic resonance imaging.METHODS: A retrospective chart review identified all neonates with PFSDHs for whom neurosurgical consultations were obtained for treatment planning.RESULTS: There were nine male and six female patients. The mean gestational age was 39 weeks. Nine of the 15 mothers of the patients were primiparous. Instrument-assisted delivery (forceps and/or vacuum extractor) was undertaken for seven patients. The mean birth weight of the infants was 3165 g (range, 2160-3930 g). The mean Ei-minute Apgar score was 7.5. Symptoms of PFSDH developed within the first 24 hours of life in 13 neonates. The predominant symptoms and signs were failure to thrive, irritability, seizures, apnea, and bradycardia. Lumbar punctures to rule out central nervous system sepsis were performed in six neonates. Hemograms revealed that six neonates were anemic with low hemoglobins, five had low platelets, and four had abnormal prothrombin and/or partial thromboplastin times at the time of diagnosis. Computed tomography established the diagnosis of PFSDH in all cases. Magnetic resonance imaging was performed for two neonates. The median time to diagnosis by imaging studies was 10 hours after birth. Surgical evacuation of the PFSDHs was performed in eight neonates. Seven neonates were followed conservatively with serial imaging studies. There was no mortality in either treatment group. Follow-up ranged from 2 to 10 years, with a mean of 4.5 years. Functional outcome assessment revealed that seven neonates were neurodevelopmentally normal, three were mildly delayed, two were moderately delayed, and three were profoundly delayed. In addition to traumatic causes of the PFSDHs, three neonates were observed to have coagulation disturbances at birth and one was observed at follow-up to have a posterior fossa medulloblastoma that had bled at birth.CONCLUSION: PFSDHs are rare but important lesions to diagnose early in the neonatal period. Surgery can be life-saving when performed in a timely manner for signs and symptoms of brain stem dysfunction. A search for an underlying cause predisposing to a PFSDH may, on occasion, reveal a coagulation disturbance or a neoplasm that will require additional therapeutic considerations.