Saito Hiroshi, Tanaka Michihiro, Hadeishi Hiromu
Department of Surgical Neurology, Kameda Medical Center.
No Shinkei Geka. 2020 May;48(5):407-412. doi: 10.11477/mf.1436204202.
Organized hematoma is a rare, non-neoplastic, and hemorrhage-prone condition that requires attention due to the risk of intraoperative bleeding. Preoperative embolization was performed to ensure intraoperative hemorrhage control. Here, we report a case of preoperative embolization of an organized hematoma using a low-concentration of n-butyl-2-cyanoacrylate(NBCA). An 80-year-old male presented with a 2-month history of repeated nasal bleeding and nasal obstruction. Diagnostic imaging revealed a mass measuring 3.7 cm in the right maxillary sinus with thinning of the surrounding bone. This was diagnosed as an organized hematoma with a biopsy. As a preoperative treatment, embolization of the main feeding artery was performed through the external carotid artery, using a low concentration of NBCA(5%). When the NBCA cast had reached the organized hematoma, as observed on plain CT, endoscopic sinus surgery was performed, and the organized hematoma was resected without significant bleeding. Preoperative embolization of the organized hematoma with low-concentration NBCA was useful to prevent heavy intraoperative bleeding.
机化性血肿是一种罕见的、非肿瘤性且易出血的病症,由于存在术中出血风险,需要引起关注。术前进行了栓塞以确保术中出血得到控制。在此,我们报告一例使用低浓度氰基丙烯酸正丁酯(NBCA)对机化性血肿进行术前栓塞的病例。一名80岁男性有2个月反复鼻出血和鼻塞的病史。诊断性影像学检查显示右侧上颌窦有一个3.7厘米的肿块,周围骨质变薄。经活检诊断为机化性血肿。作为术前治疗,通过颈外动脉对主要供血动脉进行栓塞,使用低浓度NBCA(5%)。当在平扫CT上观察到NBCA铸型到达机化性血肿时,进行了鼻内镜鼻窦手术,机化性血肿被切除,且无明显出血。用低浓度NBCA对机化性血肿进行术前栓塞有助于防止术中大出血。