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新生兒后顱窩硬膜下血腫

　　This newborn female was born at a gestational age of 40 weeks,weighing 3780g, to a gravida 2 para 1 mother. Forceps were applied to the fetal head for failure to progress. Apgar scores were 6 and 9.  Within the 1st day of life, the baby was observed to be listless and lethargic and to have a poor  suck. The anterior fontanelle was tense. Seizures developed.   Endotracheal

intubation and ventilation were required for bradycardia and apneic episodes. The hemogram was normal. A lumbar puncture was performed to rule out  central nervous system sepsis, and bloody cerebrospinal fluid(CSF) was obtained. CT was then performed，  and a large PFSDH was observed in addition to moderate ventriculomegaly. A neurosurgical consultation was obtained. The neonate was quad**legic on a ventilator, making only the occasional respiratory effort.

　　The neonate was taken urgently to surgery, and a posterior fossa craniectomy was performed. The clot could be removed from the posterior fossa subdural space. The bleeding sites were identified and successfully coagulated.  The infant did not require an external ventricular drain nor did she go on to develop progressive hydrocephalus. She began to breathe readily after the   posterior fossa decompression and clot evacuation. She was weaned from the ventilator within 4 days. Subsequent CT showed minimal left cerebellar parenchymal involvement with calcification and volume loss. The ventriculomegaly had resolved completely. At 4 years of age, the child walked and talked normally. A right esotropia remained that had persisted since surgery.