Embolization of the middle meningeal artery for acute epidural hematoma: illustrative case.

Kenji Fukutome, Sung-Ho Kim, Junji Fukumori, Taigi Fujita, Motoki Fukunaga, Yuki Shiraishi, Atsuko Shimotsuma, Rinsei Tei, Shuta Aketa, Yasushi Motoyama
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Abstract

Background: Acute epidural hematoma (AEDH) is a life-threatening traumatic brain injury typically managed with emergency craniotomy. Endovascular embolization of the middle meningeal artery (MMA) is effective in controlling hemorrhage and preventing epidural hematoma evacuation. In previous studies, concomitant surgical interventions have been commonly applied for other intracranial lesions. Transarterial embolization (TAE), the only definitive treatment that can completely eliminate the need for surgery in all associated intracranial pathologies, is rarely performed.

Observations: Here, the authors present the case of a 24-year-old female patient with AEDH who exhibited a leakage sign on CT angiography, which was indicative of active bleeding and possible hematoma expansion. Immediate MMA embolization was performed. Hemostasis was achieved using coils, without the need for surgical interventions. The patient had favorable outcomes, including resolution of headache, absence of neurological deficits, and complete hematoma regression at 1 month. Craniotomy was not performed, and the patient had high satisfaction in terms of cosmetic outcomes.

Lessons: TAE can be a safe and effective primary treatment for AEDH in some patients. In particular, it can completely prevent surgery and its associated morbidities. Early endovascular intervention for leakage signs should be promptly considered to achieve rapid hemostasis and prevent hematoma expansion, even with limited surgical access. https://thejns.org/doi/10.3171/CASE25521.

急性硬膜外血肿的脑膜中动脉栓塞:说明性病例。
背景:急性硬膜外血肿(AEDH)是一种危及生命的创伤性脑损伤,通常采用紧急开颅术治疗。脑膜中动脉血管内栓塞是控制脑膜出血和防止硬膜外血肿排出的有效方法。在以往的研究中,其他颅内病变通常采用手术干预。经动脉栓塞(TAE)是唯一可以完全消除所有相关颅内病变手术需要的明确治疗方法,但很少被采用。观察:在这里,作者报告了一位24岁的AEDH女性患者,她在CT血管造影上表现出渗漏征象,这表明活动性出血和可能的血肿扩张。立即进行MMA栓塞。止血使用线圈,无需手术干预。患者的预后良好,包括头痛消退,无神经功能障碍,1个月时血肿完全消退。未开颅手术,患者对美容效果满意度高。经验教训:TAE可以作为一些AEDH患者安全有效的主要治疗方法。特别是,它可以完全防止手术及其相关的发病率。对于渗漏征象应及时考虑早期血管内介入治疗,以实现快速止血,防止血肿扩张,即使手术通路有限。https://thejns.org/doi/10.3171/CASE25521。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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