• Thomas Blauwblomme, Matthew Garnett, Estelle Vergnaud, Nathalie Boddaert, Marie Bourgeois, Federico Dirocco, Michel Zerah, Christian Sainte-Rose, and Stéphanie Puget.
• AP-HP, Hôpital Necker Enfants Malades, Department of Pediatric Neurosurgery, Paris, France. thomas.blauwblomme@nck.aphp.fr
• Neurosurgery. 2013 May 1;72(5):755-62; discussion 762.

BackgroundSymptomatic posterior fossa hematoma in the term newborn is rare.ObjectiveTo report on the management and outcome of posterior fossa subdural hematoma (PFSDH) in neonates.MethodsA retrospective analysis of the department database and clinical notes of neonates admitted since 1985 with a PFSDH was performed together with a literature review of similar case series.ResultsSixteen patients were included. The median gestational age was 40 weeks with a high proportion of primiparous mothers (n = 9) and forceps delivery (n = 9). Nine neonates had symptoms of brainstem dysfunction within the first 24 hours of life, whereas the other 7 had a delayed presentation (median 4 days) with signs of raised intracranial pressure due to hydrocephalus. Each patient had a cranial ultrasound followed by computed tomography scan that showed the PFSDH. Eleven neonates required surgical evacuation of the PFSDH, whereas hydrocephalus was managed by transient external ventricular drainage in 2 further patients. Eventually, 2 neonates required a permanent ventriculoperitoneal shunt. Five neonates had no operative intervention. With a mean follow-up of 7.8 years, 2 patients had mild developmental delay and 1 had severe developmental delay. The 13 other patients had a normal development.ConclusionIn neonates with a PFSDH, surgery can be safely performed in those who have clinical and radiological signs of brainstem compression or hydrocephalus. A small number of neonates require a ventriculoperitoneal shunt in the long term. Initial aggressive resuscitation should be performed even in cases of initial severe brainstem dysfunction because of the good long-term neurological outcome.

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