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 of Pediatric Cardiology, Saarland University Hospital, Homburg/Saar, Germany
2
Department of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
3
Department of Neurosurgery, Saarland University Hospital, Homburg/Saar, Germany
4
Department of Pediatrics and Neonatology, Saarland University Hospital, Homburg/Saar, Germany
5
Department of Pediatric Neurology, Saarland University Hospital, Homburg/Saar, Germany

Correspondence Key Clinical Message

Martin Poryo, Department of Pediatric
Cardiology, Saarland University Hospital, We report on a newborn with a large, high parieto-frontally located mass after
Kirrberger Straße, 66421 Homburg/Saar, vacuum extraction. Imaging methods revealed a large subcutaneous collection
Germany. Tel: +49 6841 16 28306; of cerebrospinal fluid and hemorrhage. Traumatic dura lesions should be con-
Fax: +49 6841 16 28330; sidered in neonates presenting with a large head lump after assisted delivery
E-mail: martin.poryo@uks.eu
with vacuum extraction.
Funding Information
No sources of funding were declared for this Keywords
study.
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 con-
traction 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 Figure 1. Clinical presentation before first duraplasty demonstrating
enlargement of the mass. Intraoperatively, the lesion of a large, high parieto-frontal located mass.

ª 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. 101
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Vacuum extraction-caused dura lesion
(A)
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 perma-
nent 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 deliv-
eries 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.
102
M. Poryo et al.
(B)
(C)
Conflict of Interest
None declared.
References
1. Ek
eus, 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.