title: Full-Endoscopic Transforaminal Approach for Removal of a Spontaneous Spinal Epidural Hematoma.
abstract: BACKGROUND
  The incidence of spinal epidural hematoma (SEH) is estimated to be 1 per 1,000,000 patients per year; SEH can be classified as idiopathic, spontaneous, and secondary. The cause of spontaneous SEH is uncertain but it may be associated with minor trauma. SEH can compress surrounding structures, shown by clinical symptoms and signs that affect the spinal cord or nerve roots. Surgical treatment may be considered if medical treatment fails.
  
  
  METHODS
  A 26-year-old man presented with lower back pain and significant radicular symptoms on the left side for a week. He denied previous lumbar trauma or the use of anticoagulation drugs. We used the full-endoscopic transforaminal approach (extraforaminal technique) to remove the SEH under local anesthesia. The patient was discharged home 2 days after surgery and the radicular pain disappeared completely. Three months later, follow-up magnetic resonance imaging showed that the dark-brown lesion had been totally removed.
  
  
  CONCLUSIONS
  Spontaneous SEHs are uncommon. Although lumbar laminectomy is the mainstream treatment in those with neurologic deficits caused by epidural hematomas, the percutaneous full-endoscopic transforaminal approach may be an option for certain SEHs.
authors: Department of Neurosurgery, Changhua Christian Hospital, Changhua City, Taiwan.
authors: Zong-Yang
authors: ZY
authors: Wu
authors: Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors: Yong-Jian
authors: YJ
authors: Zhu
authors: Department of Othopaedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors: Lei
authors: L
authors: Chu
authors: Department of Neurosurgery, Changhua Christian Hospital, Changhua City, Taiwan.
authors: Chun-Yuan
authors: CY
authors: Cheng
authors: Department of Neurosurgery, Changhua Christian Hospital, Changhua City, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: 96015@cch.org.tw.
authors: Chien-Min
authors: CM
authors: Chen
authors: Department of Pathology, Changhua Christian Hospital, Changhua City, Taiwan.
authors: Hsu
authors: H
authors: Hui-Ting
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D046748:Hematoma, Epidural, Spinal / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male
keywords: Extraforaminal; Full endoscopic; Lumbar spine; Spinal epidural hematoma; Transforaminal