Sergio Del Villar

Hematoma de fosa posterior no traumático: consideraciones clínicas y terapéuticas

Fifty two patients (28 male and 24 female) with non-traumatic posteriorfossa hematomas were analyzed. Average age of the patients was 60 yearsold. In ten cases (19.2%), the hematomas were secondary to arteriovenousmalformations (5), cavernomas (3), venous angiomas (1) and hemangioblastoma (1). Forty two (80.7%) wereconsidered primary, with a history of high blood pressure in 31 patients and coagulation disorders in 5. Six caseshad no predisposing factors. Most subjects also had intercraneal hypertension (84%). Computerized tomographyshowed hematomas in all cases, of which four were under 2 cm in size, 24 were between 2 and 3 cm, and 24were larger than 3 cm. Hydrocephalus was present in 22 cases (42.3%). Twelve patients underwent digitalangiography, with favorable results in seven (5 arteriovenous malformations, 1 venous angioma and 1hemangioblastoma). Magnetic resonance imaging was done with two patients, and showed one cavernousangioma. Thirty-one patients underwent surgery; the hematoma was drained in 24 cases, 14 of which involvedLCR draining. The remaining cases were treated for hydrocephalus only. Favorable results were seen in 67.3% ofthe cases, and the overall mortality rate was 9.6%. Surgical mortality was 12.5%. The initial state ofconsciousness and size had a bearing on results. We believe that treatment must be evaluated on a case-by-casebasis, since no single factor has an absolute effect on a patients outcome.