Efficacy of endovascular surgery for the treatment of acute epidural hematomas.
OBJECTIVE
Recent advances in the equipment and technology for endovascular surgery have led to an increasing number of patients undergoing this procedure to treat various lesions. The purpose of this study was to investigate the efficacy of early-stage endovascular surgery to treat growing acute epidural hematomas (AEDHs).


METHODS
Over a period of 2.5 years, endovascular intervention was performed in nine patients with AEDHs, as shown by the extravasation of contrast medium and the recognition of growing hematomas on CT scans. Embolization was performed by using catheters superselectively advanced with a microguidewire until it reached the area just before the bleeding point.


RESULTS
In all nine cases, bleeding from the middle meningeal artery ceased immediately after treatment, and further surgical intervention was avoided. In three of five patients with additional lesions, surgical intervention was also conducted to treat an acute subdural hematoma (two patients) or a contusion hematoma (one patient); in two cases, these lesions were located on the contralateral side.


CONCLUSIONS
In patients with thin AEDHs in the early stage, angiography followed by endovascular intervention allows for conservative treatment. Notable clinical benefits can be achieved in patients with complicated, multiple lesions.
Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan.
Sachio
S
Suzuki
Masataka
M
Endo
Akira
A
Kurata
Taketomo
T
Ohmomo
Hidehiro
H
Oka
Takao
T
Kitahara
Takashi
T
Ohwada
Satoshi
S
Utsuki
Kiyotaka
K
Fujii
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001924:Brain Concussion / Q000150:complications / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D015897:Comorbidity; D004292:Dominance, Cerebral / Q000502:physiology; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006407:Hematoma, Epidural, Cranial / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D020199:Hematoma, Subdural, Acute / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008576:Meningeal Arteries / Q000000981:diagnostic imaging / Q000293:injuries; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000000981:diagnostic imaging; D012887:Skull Fractures / Q000150:complications / Q000000981:diagnostic imaging; D013701:Temporal Bone / Q000293:injuries; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome