Combined Endovascular and Endoscopic Surgery for Acute Epidural Hematoma in a Patient With Poor Health

Abstract

A 74-year-old woman presented with right acute epidural hematoma (AEDH) associated with a skull fracture after a fall. Emergency craniotomy under general anesthesia could not be performed because of her poor medical condition. Therefore, transfemoral endovascular embolization and hematoma evacuation via a burr hole were performed using endoscopy under local anesthesia. The patient recovered and was discharged without neurological deficits. AEDH is a common traumatic disease often requiring emergency craniotomy to prevent death and restore neurological function. The present combined surgical approach was effective in treating AEDH that could not be treated under general anesthesia in a patient with poor medical condition.

Endovascular management of acute epidural hematomas: clinical experience with 80 cases

“…The patient originally had an SDH and developed an EDH (which was drained in a second operation) but rebled and was finally treated successfully with embolization. Ohshima et al 20 described the combined treatment of a large EDH with bur hole endoscopic evacuation and MMA embolization in a 74-year-old patient in poor medical condition. Kim et al 13 described the usefulness of intraoperative embolization of an MMA pseudoaneurysm for hemostasis as a desperate measure to control acute, life-threatening, uncontrollable bleeding.…”

“…vascular lesions associated with small EDHs has been proposed as a safe and effective treatment option. 6,20,24,28 In this paper, we describe our experience with the endovascular management of EDHs in 80 consecutive patients (thus far the largest reported series to the best of our knowledge), and compare it with historical cohorts.…”

The effectiveness of palliative middle meningeal artery embolization prior to craniotomy for large acute epidural hematoma: A case report

“…Endovascular treatment, commonly used for various conditions, has been applied in trauma patients for issues like traumatic carotid cavernous fistulas, pseudoaneurysms, and intractable bleeding. Reports exist of endovascular embolization for small acute epidural hematomas, demonstrating no postoperative complications [ [11] , [12] , [13] , [14] ]. In a previously reported case, we performed MMA embolization for a small acute epidural hematoma in a 65-year-old man who had sustained an injury from a fall.…”

Traumatic epidural hematoma treated with endovascular coil embolization

“…A review of the literature, including the present case, revealed 15 articles of embolization for EDH in 153 patients [ Table 1 ]. [ 3 , 5 , 8 , 19 , 21 , 22 , 24 , 27 , 29 , 32 , 36 , 39 , 41 , 42 ] In 98.0% of cases (150/153), EDH occurred due to traumatic injury; 1 case (0.69%) was caused by a nontraumatic dural arteriovenous fistula. [ 39 ] The MMA was embolized in all cases (100%), leading to successful outcome with no complications in all but 1 complicated case, where the patient died of hypoxic injury and medical conditions 2 months after treatment for intracranial hemorrhage requiring an external ventricular drain.…”