Chronic posterior fossa subdural hematoma: a case report of endovascular management and systematic review
Hematoma subdural crónico de la fosa posterior: reporte de un caso de manejo endovascular y revisión sistemática
Luis Gustavo Biondi Soares, Emilly Beatriz Aleixo Almeida, Raívson Diogo Felix Fernandes, Emanuella Arruda do Rego Nóbrega, Joyce Maria Menezes Grangeiro, Jamyle Grescy dos Santos Oliveira, José Miguel Aiquel Bellolio, José Alencar de Sousa Segundo, Leandro de Assis Barbosa
Abstract
Chronic subdural hematoma (CSDH) commonly affects elderly patients, but posterior fossa involvement is exceedingly rare, representing less than 1% of cases. Due to the restricted infratentorial space, even small hematomas may cause neurological deterioration. To systematically review the management of posterior fossa CSDH in adults and report a rare case treated with middle meningeal artery (MMA) embolization. PubMed and Scopus searches identified 106 articles. After duplicate removal and eligibility screening, 20 studies comprising 21 patients were included. Clinical presentation, imaging findings, treatment, and outcomes were analyzed. Mean patient age was 64.2 years, with female predominance (76%). Headache (76%), ataxia (57%), and vertigo (33%) were the most common symptoms. Surgical evacuation, mainly via suboccipital craniotomy or burr-hole drainage, was performed in 81% of cases, while conservative treatment was used in 14%. Only one previous case reported successful MMA embolization. Outcomes were generally favorable, without recurrence. We also report a 57-year-old woman with multiple myeloma and severe thrombocytopenia who developed spontaneous supratentorial and posterior fossa CSDH. Due to surgical contraindications, MMA embolization was performed, leading to complete radiological resolution and full neurological recovery. Posterior fossa CSDH is rare and potentially life-threatening, requiring prompt diagnosis and individualized treatment.
Keywords
Resumen
El hematoma subdural crónico (HSDC) afecta principalmente a pacientes ancianos, pero la afectación de la fosa posterior es extremadamente rara, representando menos del 1% de los casos. Debido al espacio infratentorial restringido, incluso pequeños hematomas pueden causar deterioro neurológico. Revisar sistemáticamente el manejo del HSDC de fosa posterior en adultos y reportar un caso tratado con embolización de la arteria meníngea media (AMM). Las búsquedas en PubMed y Scopus identificaron 106 artículos. Tras eliminar duplicados y aplicar criterios de elegibilidad, se incluyeron 20 estudios con 21 pacientes. Se analizaron presentación clínica, hallazgos de imagen, tratamiento y resultados. La edad media fue de 64,2 años, con predominio femenino (76%). Los síntomas más frecuentes fueron cefalea, ataxia y vértigo. La evacuación quirúrgica fue el tratamiento principal (81%), mientras que el manejo conservador se utilizó en el 14%. Solo un caso previo describió embolización exitosa de la AMM. Además, presentamos una mujer de 57 años con mieloma múltiple y trombocitopenia grave tratada exitosamente mediante embolización. El HSDC de fosa posterior es una entidad rara y potencialmente grave que requiere diagnóstico precoz y manejo individualizado.
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References
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Submitted date:
04/25/2026
Reviewed date:
05/14/2026
Accepted date:
05/26/2026
Publication date:
07/04/2026
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