[Angiographical extravasation of contrast material in traumatic epidural hematomas--the clinical significance and surgical indication (author's transl)].

During the last 17 years since 1958, 108 cases with traumatic epidural hematomas were treated in our clinics, and the extravasation from the middle meningeal artery was observed in 20 cases (18%) out of them. The clinical significance of the extravasation will be discussed in association with the indication of surgical intervention. Common carotid angiographies were performed in all of 20 cases, and selective external carotid angiographies were also performed in 2 of them. The time interval from the injury to the angiographical confirmation of extravasation ranged from an hour to ten days. In 14 cases, it was confirmed at the acute stage less than 3 days after the injury, and in the remaining 6 cases it was confirmed at the subacute stage more than 3 days after the injury. Surgical removal of the hematomas was performed in 16 cases, and no surgery was done in the other 4 cases mainly because of slight hemorrhage in the cranial cavity. The extravasation from the middle meningeal artery, which was usually observed to overlap the fracture line or in the neighbourhood of it, was classified into the following three types according to the angiographic contours: 1. Estravasation of contrast material into the perivascular tissue (11 cases): Though it was stated in the literatures that this type of extravasation was usually observed less than 6 hours after the injury, it was confirmed at the subacute stage in our 3 cases out of 11, and even ten days later in a case. Angiographically, it is demonstrated to be an irregular band-like configuration (3 cases), scattered spots (2 cases), round shadow (2 cases), semicircular contour (2 cases) or irregular maplike shadow (2 cases), all of which changed in shape and density through the arterial phase to the end of the venous phase. All of the 11 cases showed large epidural hematomas, and the angiographical extravasation coincided with the site of actual bleeding which was confirmed at the operation. 2. A berry-shaped well-defined round shadow of high density communicating with the arterial lumen--pseudo-aneurysm-like shadow (2 cases): In one, a berry-shaped shadow was discovered in the angiography performed 17 hours after the injury. A small cavity which was surrounded by epidural clot and communicated with the middle meningeal artery was discovered at the operation, and considered to be the site of actual bleeding, since an arterial bleeding through the cavity was noticed. In the other, a berry-shaped shadow which appeared as soon as the middle meningeal artery was demonstrated and disappeared by the late venous phase was angiographically discovered 10 days after the injury. A epidural hematoma was slightly formed and operation was not performed. Two months later, the pseudoaneurysm-like shadow was not demonstrated angiographically. 3...