Pavlov A. Traumatic Intracranial Hematomas of Posterior Cranial Fossa. Craniometrical Characteristics, Diagnostics and Treatment

The Thesis provides the theoretical synthesis and the new approach to the relevant applied science-based neurosurgery objective – to improve the efficiency of diagnostics and treatment of patients with hematomas of posterior cranial fossa based on the study of craniometrical characteristics of the anatomical structures of posterior cranial fossa, determination of the critical volume of posterior cranial fossa as the exponent of anatomically “tight” posterior cranial fossa and identification of the critical correlation of the volumes of the hematoma and the posterior cranial fossa. The paper analyses the results of clinical and instrumental examination and treatment of the 100 patients with verified traumatic hematomas of posterior cranial fossa. Based on the clinical and anatomical forms of injury of posterior cranial fossa structures, intracranial hematomas of posterior cranial fossa, 5 forms have been abstracted: the patients with posterior cranial fossa injuries located in infratentorial and supratentorial regions – epidural hematomas (63 observation cases - 46%), subdural hematomas (23 observation cases – 16,8%), intracerebellar hematomas (16 observation cases – 11,7%), intraventricular hematomas (27 observation cases – 19,7%), hematomas located inside the fourth ventricle and aqueduct of cerebrum as well as multiple hematomas (8 observation cases 5,8%). The posterior cranial fossa volume was estimated on the computed tomography scans and magnetic resonance images and improved mathematical model expressed by the following formula was used: V = 1/3 S ? (b + c (a2 + ae + e2) / a2), in which S = ?ad / 4. According to the findings, posterior cranial fossa volume in adults varies from 140 to 230 cm3, averagely — 178±19.14 cm3, which requires individualization and discriminate methods of treatment of traumatic intracranial hematomas of posterior cranial fossa. It has been evidenced that the craniometrical sign of anatomically “tight” posterior cranial fossa is the increase in correlation of brain matter volume of posterior cranial fossa and its bone volume, and the posterior cranial fossa volume less than 178 cm3 is suggested to be considered as anatomically “tight” posterior cranial fossa. Analysis of treatment of the patients with traumatic hematomas of posterior cranial fossa as well as the implemented mathematical model allows determining the criteria for discriminate use of surgical treatment in which the correlation of hematoma and posterior cranial fossa volumes greater than 14% substantiates the rationality of and justifies the indication for surgical intervention.