Novel Minimally Invasive Treatment Strategy for Acute Traumatic Epidural Hematoma: Endovascular Embolization Combined with Drainage Surgery and Use of Urokinase

• Published in: World neurosurgery Vol. 110; pp. 206 - 209
• Main Authors: Zhang, Yuhui, Li, Qiang, Zhao, Rui, Yang, Zhigang, Li, Yanan, Min, Weijie, Yue, Zhijian, Liu, Jianmin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2018
• Subjects: Adolescent; Adult; Angiography, Digital Subtraction; Drainage - methods; Drainage surgery; Embolization; Embolization, Therapeutic - methods; Endovascular treatment; Epidural hematoma; Female; Hematoma, Epidural, Cranial - diagnostic imaging; Hematoma, Epidural, Cranial - drug therapy; Hematoma, Epidural, Cranial - surgery; Humans; Male; Meningeal Arteries - diagnostic imaging; Meningeal Arteries - surgery; Middle Aged; Minimally Invasive Surgical Procedures - methods; Tomography, X-Ray Computed; Treatment Outcome; Urokinase-Type Plasminogen Activator - therapeutic use; Young Adult; MMA; CT; Endovascular treatment; Epidural hematoma; GCS; Drainage surgery; EDH; Embolization
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2017.11.047

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.