Acute epidural hematoma is one of the common and critical conditions in neurosurgery,characterized by sudden onset,rapid progression of symptoms,and high rate of disability.Although common surgical procedures such as craniotomy and burr hole drainage can effectively remove the hematoma,some patients still suffer from progression of the hematoma and deterioration of their condition due to lack of treatment for the responsible blood vessel.This paper reported a 75-year-old female who was admitted to the hospital with a 3-hour history of loss of consciousness due to a traffic accident.CT scan revealed an acute epidural hematoma that overlies the right frontal and parietal lobes,with a volume of approximately 28 ml.The patient was planned to undergo interventional embolization to control the bleeding and a second operation for burr hole drainage.After femoral artery puncture in the angiography room,the patient's right pupil gradually dilated to 5 mm,which was considered to be the progression of the hematoma causing a herniation.A Dyna-CT scan confirmed the rapid expansion of the hematoma,and a volume of 65 ml hemotoma was immediately drainaged.Angiography revealed that the distal branches of the right middle meningeal artery(MMA)were leaking contrast agent,confirming its rupture and active bleeding,which was treated with Onyx glue embolization.Dyna-CT-guided puncture and drainage of 205 ml of blood was performed after the embolization.Subsequently,a craniotomy was performed,with a right temporal-parietal-occipital horseshoe-shaped incision and a 12 cm×10 cm bone window,and approximately 80 ml of subdural hematoma was removed.Radial incision of the dura mater was performed afterward,and approximately 20 ml of subdural hematoma was removed.Then the bone flap was removed.One day after the craniotomy,CT scan showed that the hematoma had been mostly removed,and no new hematoma was found.At the 8-month follow-up,the GCS score was 15,and the right limb had a muscle strength of grade V,while the left upper limb had a muscle strength of 0 and the left lower limb had a muscle strength of grade Ⅲ.Therefore,for acute epidural hematoma,it is important to accurately determine the location,nature,source of bleeding,and progression of the hematoma,fully understand the advantages and disadvantages of various treatment methods,and choose an appropriate treatment method in a timely manner to develop an individualized treatment plan,in order to achieve good treatment outcomes.
关键词
急性硬膜外血肿/进展性硬膜外血肿/复合手术/血管内治疗/钻孔引流术/开颅血肿清除术
Key words
Acute epidural hematoma/Progressive extraparenchymal hematoma/Hybrid surgery
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