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.
With Good Outcomes at Long-Term Follow-Up
In all cases, surgery was successful in eliminating the hematoma and normalizing intracranial pressure. Two infants required shunt placement to keep fluid from building up in the skull (hydrocephalus). All 16 infants survived.
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).
Most patients with who were followed up to adolescence or young adulthood were attending normal school or independently employed. The changes of such good outcomes appeared lower for patients whose PFSDH involved a part of the brain called the cerebellum.
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 treatmentincluding surgery, if neededmost 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
|Contact: Connie Hughes|
Wolters Kluwer Health