gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Severe dural tear and brain injury after vacuum extraction birth

Meeting Abstract

  • Sebastian Senger - Department of Neurosurgery, Medical School Saarland University, Homburg/Beeden, Deutschland
  • Christina Flohr - Kinder- und Jugendmedizin, Marienhausklinik St.Josef Kohlhof, Neunkirchen, Deutschland
  • Otto Schofer - Kinder- und Jugendmedizin, Marienhausklinik St.Josef Kohlhof, Neunkirchen, Deutschland
  • Joachim Oertel - Universitätskliniken des Saarlandes, Neurochirurgische Klinik, Klinik für Neurochirurgie, Homburg/Saar, Deutschland
  • Stefan Linsler - Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.16.06

doi: 10.3205/17dgnc271, urn:nbn:de:0183-17dgnc2719

Published: June 9, 2017

© 2017 Senger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Traumatic brain lesions after vacuum extraction delivery are rare. Most common complication after operative vaginal deliveries is subgaleal hematoma applied by trained obstetricians. There are only single case reports about major complications after vacuum extraction delivery in the literature available. Here, the authors present a case of a severe brain damage and dura tear after vaccum extraction delivery.

Methods: A 2980-g female infant was born at 39 weeks via vacuum. The baby was in an occipitoposterior position when arrest of birth occurred. A VE was performed with Kiwi Omni Cup with one pull of 8 minutes duration. A large cephalic hematoma was visible directly after delivery at the frontal part. Because of generalized epileptic seizure on second day after birth as MRI scan was performed demonstrating a severe dural tear with large subgaleal CSF accumulation and subgaleal haemorrhage. Also damage of the dorsofrontal lobe and a brain prolapse was detected.

Results: In the presented case surgical treatment of the dural tear was required. Five month after initial surgical closure of dural tear a revision surgery with new duraplasty and also fixation of an autologous bone graft was necessary cause of persistend CSF fistula. Additionally, ventriculoperitoneal shunting was necessary one week after second surgery cause of posttraumatic hydrocephalus. In last follow up after 11 month, the girl was noted to have recovered completely.

Conclusion: Long-term follow-up of babies born via vacuum extraction who experienced brain damage usually shows complete resolution of hemorrhage and show a regular neurological development as presented in this case. Surgery is only required in rare cases of severe dural ruptures preventing persisting CSF fistulas. In case of severe dural tears and possible posttraumatic hydrocephalus bone graft and external ventricular drainage or ventriculoperitoneal shunting might be necessary additional to duraplasty.