The role of endoscopy in the treatment of acute traumatic anterior epidural hematoma of the cervical spine: case report.
OBJECTIVE
Epidural hematoma (EDH) of the spine represents an uncommon neurosurgical disorder that sometimes requires emergent surgical decompressive therapy. Traumatic EDH of the cervical spine is exceedingly rare. The hematoma is usually located dorsally in the epidural space. We present one case of acute EDH located ventrally in the cervical spine. Special emphasis is placed on the role of spinal endoscopy in surgical treatment.


METHODS
After a fall from a tree, a 69-year-old man with rapidly increasing tetraparesis was referred to our institution. Plain films of the cervical spine revealed nothing abnormal. The results of computed tomography were highly suspicious for EDH. A myelogram and a post-myelographic computed tomographic scan demonstrated the lesion and its extent craniocaudally.


METHODS
Emergency decompressive surgery and removal of the hematoma were performed via an anterior approach. Control for total removal of the EDH was achieved using a flexible neuroendoscope providing visualization of the anterior epidural space from the foramen magnum to the T1 level. Surgery was accomplished by vertebral body replacement and anterior plating.


CONCLUSIONS
Spinal endoscopy seems to be a useful tool in the surgical treatment of spinal EDH, providing control of the adjacent levels and allowing the limitation of the extent of bony resection.
Kessel
G
G
Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany.
Böcher-Schwarz
H G
HG
Ringel
K
K
Perneczky
A
A
D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical / Q000295:instrumentation*; D004630:Emergencies; D019723:Endoscopes; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008297:Male; D009460:Neurologic Examination; D012086:Reoperation; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*