锥颅治疗12例儿童后颅窝硬膜外血肿的临床体会

Treatment of posterior fossa epidural hematomas in children by drilling skull： reports in 12 cases

目的分析12例儿童后颅窝硬膜外血肿的诊断与治疗。方法回顾性分析天津环湖医院2008—2012年收治的12例儿童后颅窝硬膜外血肿患者。通过连续复查头颅CT，发现该组患者硬膜外血肿早期CT即表现为等密度或混杂密度，全部病例均在局麻下颅骨锥孔血肿抽吸。结果12例患者均恢复良好，无术后再出血，无严重并发症及死亡。结论后颅窝硬膜外血肿早期临床症状较轻且不特异，血肿量一旦增加，将严重威胁生命，故应密切观察CT变化，动态复查头颅CT；后颅窝硬膜外血肿早期常常即可呈液态，锥孔血肿抽吸是治疗这部分患者的有效治疗手段，但应严格把握手术时机、手术适应证及禁忌证。

Objective To introduce the diagnosis and treatment of posterior fossa epidural hematomas of 12 cases in children. Methods 12 children who admitted into Tianjin Huanhu Hospital from 2008 to 2012 with posterior fossa epidural hematomas were evaluated. Through continuous review of head CT,epidural hematoma was found that manifested as isodense or mixed density in early period, and all patients were treated with cranial - pricking, hematoma aspiration without drainage tube. Results All patients recoverd well,there was no delayed hematoma,no serious complications and death. Conclusion The early clinical symptoms of posterior cranial fossa epidural hematoma is mild and not specific, but enlarge of the hematoma is a serious threat to life, so consequent review of head CT is necessary. The hematoma is often liquid in early stage, and the method of cranial - pricking can be used. But the timing of surgery, surgical indications and contraindications should be strictly controlled.