Traumatic posterior fossa extradural hematoma in children: a meta-analysis and institutional experience of its clinical course, treatment and outcomes

Posterior fossa extradural hematoma (PFEDH) is rare but has a greater incidence amongst children. It is also associated with a rapid deterioration. The aim of this study was to present the management of PFEDH through our institutional experience and a meta-analysis. A retrospective single institution review of all children from 2004 to 2024 who underwent craniotomy for PFEDH was undertaken. The collected variables included: demographics, type of trauma, clinical findings, computed tomography findings, and clinical course. A systematic review using Ovid Medline, Ovid Embase, and Cochrane Central Register of Controlled Trials (CENTRAL), and meta-analysis were performed. Nineteen children with PFEDH who underwent surgery were identified. All 19 (100%) patients benefited from good Glasgow Outcome Scale (GOS) score 4-5, and there were no incidences of in-hospital mortality. From the systematic review, 391 patients, across twenty-four studies and our series, were included. A total of 308 were treated with surgery, whereas 83 patients were treated conservatively. A comparative meta-analysis was not performed as the two groups were deemed too heterogeneous in clinical characteristics. Instead, single-arm meta-analyses were performed. The pooled incidence of patients initially under conservative management requiring surgery was 9.90% (95%CI 1.61;22.21%, I2 = 35.2). The incidence of good functional outcomes in patients managed surgically and conservatively were 93.68% (95%CI: 88.69;97.57%, I2 = 0.0%), and 99.99% (95%CI: 96.53;100%, I2 = 0.0%), respectively. Overall pooled of mortality in patients managed surgically and conservatively were 0.57% (95%CI: 0.00;2.87%, I2 = 0.0%) and 0.00% (95%CI: 0.00;1.18%, I2 = 0.0%). Overall, our study reiterates that pediatric PFEDH is uncommon, and patients often present atypically. Based on our institutional experience and extrapolating data from our meta-analysis of the wider literature, neurosurgical intervention is a reliable therapeutic option with good clinical outcomes.