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This was a nine-year-old child who was in a severe motor

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vehicle accident. If one looks at the brain windows,

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one can see that there is hemorrhage that

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is located in the posterior fossa.

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Hematomas in the posterior fossa are unique because of

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the confined space of the infratentorial compartment.

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And there the indications for surgery are different for a

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hemorrhage that occurs in the posterior fossa

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as opposed to the supratentorial space.

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In this case,

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although it seems like there's not that much hemorrhage

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associated with the injury that we will describe,

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you can see that the fourth ventricle is

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not well visualized in this individual.

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Not only that,

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but there is hemorrhage both on the right and the

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left sides of the cerebellar hemispheres.

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You also note that the patient has extensive air

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in these soft tissues of the scalp posteriorly,

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and that scalp swelling is present both

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on the right side and the left side.

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All this becomes a little bit more clear when one

1:07

looks at the bone windows.

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In the bone windows,

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one can see that the patient has a comminuted

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fracture of the occipital bone,

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both on the right side as well as on the left side,

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in this case,

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actually crossing the mastoid air cells on the left side,

1:25

and with extensive involvement of the temporal bone

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as well, here, affecting the middle ear cavity.

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You'll notice that there is air in these soft tissues along

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the left temporal region because of the communication with

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the aerated mastoid air cells from the temporal bone.

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In this situation, once again,

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it is a dramatic event to have a

1:48

posterior fossa hemorrhage,

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and this patient will be serially scanned quite rapidly

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in order to determine whether or

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not the patient is herniating.

2:00

When one has hemorrhage in the posterior fossa,

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the cerebellar tonsils may descend through the

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foramen magnum, and if they do so,

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you may have compression of the important portions

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of the brainstem, including the medulla,

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which direct respiration as well

2:18

as cardiovascular function.

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And this is a potential source of a patient's rapid demise

2:25

from cerebellar hematoma with tonsillar herniation.