Zhang Yuhui, Li Qiang, Zhao Rui, Yang Zhigang, Li Yanan, Min Weijie, Yue Zhijian, Liu Jianmin
Department of Spine Surgery, Renji Hospital, Medical School, Shanghai Jiaotong University, Shanghai, China.
Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
World Neurosurg. 2018 Feb;110:206-209. doi: 10.1016/j.wneu.2017.11.047. Epub 2017 Nov 20.
Hematoma evacuation is regular treatment for acute traumatic epidural hematoma (ATEDH) patients meeting with surgery indications. However, it is an invasive approach performed under general anesthesia. Here, a novel minimally invasive method of endovascular embolization with subsequent drainage surgery and use of urokinase was established to treat ATEDH under local anesthesia.
A novel minimally invasive method of endovascular embolization with subsequent drainage surgery and use of urokinase was established to treat ATEDH under local anesthesia. Firstly, 23 ATEDH patients with hematomas in the temporal area underwent digital subtraction angiography detecting the bleeding point. Next, embolization was performed. After embolization, drainage surgery was taken and urokinase was injected into the hematoma cyst by drainage tube to lyse hematoma twice per day.
The results showed that the middle meningeal artery was the bleeding source. Embolization immediately ceased bleeding. Most clots were resolved and drained after treatment. No recurrence of hematoma or infection was observed.
The findings suggest that the combined treatments can be an alternative minimally invasive option for ATEDHs, especially for elderly patients or those contraindicated for general anesthesia.
血肿清除术是符合手术指征的急性创伤性硬膜外血肿（ATEDH）患者的常规治疗方法。然而，这是一种在全身麻醉下进行的侵入性手术。在此，我们建立了一种新型的微创方法，即血管内栓塞联合后续引流手术并使用尿激酶，在局部麻醉下治疗ATEDH。
建立了一种新型的微创方法，即血管内栓塞联合后续引流手术并使用尿激酶，在局部麻醉下治疗ATEDH。首先，对23例颞部有血肿的ATEDH患者进行数字减影血管造影以检测出血点。接下来，进行栓塞。栓塞后，进行引流手术，并通过引流管将尿激酶注入血肿腔，每天两次以溶解血肿。
结果表明，脑膜中动脉是出血源。栓塞立即止血。治疗后大多数血凝块溶解并排出。未观察到血肿复发或感染。
研究结果表明，联合治疗可以作为ATEDH的一种替代性微创选择，特别是对于老年患者或那些有全身麻醉禁忌证的患者。
