CLINICAL IMAGE
A newborn with a large mass: vacuum extraction-caused dura lesion Martin Poryo1, Umut Yilmaz2, Stefan Linsler3, Ludwig Gortner4 & Sascha Meyer4,5 1
Department Department 3 Department 4 Department 5 Department 2
of of of of of
Pediatric Cardiology, Saarland University Hospital, Homburg/Saar, Germany Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany Neurosurgery, Saarland University Hospital, Homburg/Saar, Germany Pediatrics and Neonatology, Saarland University Hospital, Homburg/Saar, Germany Pediatric Neurology, Saarland University Hospital, Homburg/Saar, Germany
Correspondence Martin Poryo, Department of Pediatric Cardiology, Saarland University Hospital, Kirrberger Straße, 66421 Homburg/Saar, Germany. Tel: +49 6841 16 28306; Fax: +49 6841 16 28330; E-mail:
[email protected] Funding Information No sources of funding were declared for this study.
Key Clinical Message We report on a newborn with a large, high parieto-frontally located mass after vacuum extraction. Imaging methods revealed a large subcutaneous collection of cerebrospinal fluid and hemorrhage. Traumatic dura lesions should be considered in neonates presenting with a large head lump after assisted delivery with vacuum extraction. Keywords traumatic dura lesion, vacuum extraction.
Received: 9 July 2015; Revised: 22 September 2015; Accepted: 28 September 2015 Clinical Case Reports 2016; 4(1): 101–102 doi: 10.1002/ccr3.428
Clinical Case We report on a term female neonate who was born to a 24-year-old G III, P I by vacuum extraction (model KIWI) out of occiput posterior because of a pathologic cardiotocography. It was an easy extraction with two contraction synchronous tractions. During the procedure, vacuum extractor did not slip. APGAR scores at 5 and 10 min were 9 and 10. On physical examination, a large, high parieto-frontally located mass was noted which extended above the anterior fontanel (Fig. 1). Twenty-six hours postnatally, the newborn developed a focal seizure with rhythmic convulsions of the left hand and foot. On ultrasonography and cranial magnetic resonance imaging, (Fig. 2) an osseous and dural defect with consecutive subcutaneous collection of cerebrospinal fluid as well as a supra- and infratentorial subdural hematoma was detected. Humoral and cellular coagulation tests were normal. The girl was subsequently operated because of further enlargement of the mass. Intraoperatively, the lesion of
Figure 1. Clinical presentation before first duraplasty demonstrating a large, high parieto-frontal located mass.
ª 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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Vacuum extraction-caused dura lesion
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Figure 2. MRI coronal FLAIR image (A) and axial T2-weighted image (C) show the great subcutaneous collection of cerebrospinal fluid as well as the defect of the parenchyma. Sagital T1-weighted image (B) depict the accompanying supra- and infratentorial subdural hematoma.
the dura and bone could be localized measuring approximately 3 9 2 cm, and was surgically closed. After 5 months, recurrence of the swelling occurred. Because conservative treatment including pressure bandage failed, another dura- and cranioplasty were required for permanent closure. Although vacuum extraction is considered a save method, several serious complications may occur (e.g., subgaleal or intracranial hemorrhage [1]). Traumatic lesion of the dura is a rare complication in assisted deliveries by vacuum extraction [2]. Nonetheless, it should be regarded as a differential diagnosis in neonates presenting with a head lump after vacuum extraction, which does not resolve in a timely manner.
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Conflict of Interest None declared. References 1. Ekeus, C., U. H€ ogberg, and M. Norman. 2014. Vacuum assisted birth and risk for cerebral complications in term newborn infants: a population-based cohort study. BMC Pregnancy Childbirth [Internet] 14:36. Available from: http://www.biomedcentral.com/1471-2393/14/36 2. Musahl, C., and U. Schick. 2008. Severe brain injury with rupture of the superior sagittal sinus after vacuum extraction birth. J. Neurosurg. Pediatr. 1:471–473.
ª 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
