Interdisciplinary Neurosurgery (Dec 2022)
Retroclival hematomas in adult patients: A systematic review of a rare intracranial hematoma
Abstract
Objective: Adulthood retroclival hematomas (RCHs) are a rare condition characterized by intracranial bleeding along the posterior aspect of the clivus. There are few reports in the literature that describe these hematomas. There is no agreement on how to treat these hematomas. Methods: An extensive literature review was performed, and the data was classified and analyzed on this topic from January 2000 to January 2022. A systematic review was carried out in accordance with the PRISMA and CARE Guidelines. Results were analyzed and potential clinical links were extracted. Results: Twenty-seven RCHs in adulthood were reported in twenty high-quality articles. 12/27 RCHs in adults were spontaneous. Epidural retroclival hematomas were present in 12/27 patients, while subdural hematomas were present in 13/27 patients. 15 of 22 adult RCHs observed were small in size. Epidural hematomas are typically associated with trauma (9/15 traumatic RCHs), whereas subdural hematomas are more frequently associated with spontaneous bleeding (8/12 spontaneous RCHs). There was one case of hydrocephalus, six cases of cranial nerve palsies (five of which were traumatic), and thirteen cases of intraspinal extension of the hematoma. Seven individuals exhibited craniovertebral instability (100 percent traumatic). Most hematomas were conservatively treated (77.8 percent). 21 hematomas had favorable clinical outcomes. Conclusions: There is a lack of agreement on management protocols for RCHs in adulthood. These hematomas occur almost equally in both the extradural and the subdural spaces, and they are typically small in size. When an RCH occurs in the epidural space, it is more likely to result in cranial nerve palsies and craniospinal instability. Associated craniovertebral anomalies must be thoroughly analyzed in trauma patients. Only patients with a significant mass effect on the brainstem are candidates for surgical hematoma evacuation. It is imperative that future studies on this rare entity adhere to strict publication guidelines.
