Posterior Fossa Epidural Hematomas: Rare but Serious Complication of Occipitocervical Fusion Surgery.

BACKGROUND

Posterior occipitocervical fusion surgery is a commonly used surgical method to treat various craniovertebral junction pathologies. Though it is an effective method, there also have been some reports about complications of occipitocervical fusion. However, there have been no reports about posterior fossa epidural hematomas after occipitocervical fusion.

CASE DESCRIPTION: A 44-year-old female was referred to our hospital with a 6-month history of neck pain and numb limbs for 2 months. On the basis of the imaging findings of the patient, the diagnosis was basilar invagination with atlantoaxial dislocation associated with Klippel-Feil syndrome and O-C1 assimilation. According to the principle of treatment, occipitocervical fusion surgery was performed. The operation was completed successfully, and the patient awoke from anesthesia 10 minutes later and went back to the orthopedic intensive care ward. Twenty hours after surgery, her mental status had deteriorated to a stupor, and both her pupils had dilated to 5 mm. Acute posterior fossa epidural hematomas were revealed by emergent computed tomography of the brain. Emergency craniectomy decompression and epidural hematoma removal surgery were performed for her in a timely manner. However, her mental status still did not improve and she fell into a deep coma. Her pupillary reflex disappeared, and then she died.

CONCLUSIONS

Posterior fossa epidural hematoma is a rare complication of occipitocervical fusion surgery. Once it happens, it can be serious and even lead to death. It is important for the surgeons to realize that posterior fossa epidural hematomas may occur after the occipitocervical fusion surgery.