A newborn with a large mass: vacuum extraction‐caused dura lesion

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.

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.

Figure 1.

Clinical presentation before first duraplasty demonstrating a large, high parieto‐frontal located mass.

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 girl was subsequently operated because of further enlargement of the mass. Intraoperatively, the lesion of the dura and bone could be localized measuring approximately 3 × 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.

Conflict of Interest

None declared.

Clinical Case Reports 2016; 4(1): 101–102