Suzuki Sachio, Endo Masataka, Kurata Akira, Ohmomo Taketomo, Oka Hidehiro, Kitahara Takao, Ohwada Takashi, Utsuki Satoshi, Fujii Kiyotaka
Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan.
AJNR Am J Neuroradiol. 2004 Aug;25(7):1177-80.
Recent advances in the equipment and technology for endovascular surgery have led to an increasing number of patients undergoing this procedure to treat various lesions. The purpose of this study was to investigate the efficacy of early-stage endovascular surgery to treat growing acute epidural hematomas (AEDHs).
Over a period of 2.5 years, endovascular intervention was performed in nine patients with AEDHs, as shown by the extravasation of contrast medium and the recognition of growing hematomas on CT scans. Embolization was performed by using catheters superselectively advanced with a microguidewire until it reached the area just before the bleeding point.
In all nine cases, bleeding from the middle meningeal artery ceased immediately after treatment, and further surgical intervention was avoided. In three of five patients with additional lesions, surgical intervention was also conducted to treat an acute subdural hematoma (two patients) or a contusion hematoma (one patient); in two cases, these lesions were located on the contralateral side.
In patients with thin AEDHs in the early stage, angiography followed by endovascular intervention allows for conservative treatment. Notable clinical benefits can be achieved in patients with complicated, multiple lesions.
血管内手术设备和技术的最新进展导致越来越多的患者接受该手术以治疗各种病变。本研究的目的是探讨早期血管内手术治疗进行性急性硬膜外血肿（AEDH）的疗效。
在2.5年的时间里，对9例经CT扫描显示造影剂外渗且血肿增大的AEDH患者进行了血管内介入治疗。使用微导丝将导管超选择性推进，直至到达出血点前的区域进行栓塞。
所有9例患者在治疗后脑膜中动脉出血立即停止，避免了进一步的手术干预。5例有其他病变的患者中，有3例还进行了手术干预以治疗急性硬膜下血肿（2例）或挫伤性血肿（1例）；2例中，这些病变位于对侧。
对于早期薄型AEDH患者，血管造影后进行血管内介入治疗可实现保守治疗。对于合并复杂、多发病变的患者可取得显著的临床疗效。
