Ultrasonography-Assisted Bedside Technique to Identify and Aspirate Clots: Rescue for Patients with Post-Craniectomy Epidural Hematomas.

The benefits of decompressive craniectomy (DC) may be adversely affected by postoperative complications. This article presents the technique of ultrasonography (US) guidance to treat epidural hematoma (EDH) following DC for ischemic stroke.  Four patients developed postoperative EDHs requiring dual-trajectory approaches for reexploration and evacuation. Clearance and reaccumulation of the EDH was assessed by US images at the bedside.  Real-time US showed hematoma shrinkage and brain decompression during the suction-assisted evacuation. Aspiration resulted in an immediate average reduction in hematoma size from 106 mL to 30 mL. No ensuing infection and rehemorrhage occurred related to the bedside procedure.  US-guided clot evacuation is an effective minimal access surgery for patients with post-craniectomy EDHs and worsening neurologic status.