Endovascular management of acute epidural hematomas: clinical experience with 80 cases

OBJECTIVE Small acute epidural hematomas (EDHs) treated conservatively carry a nonmeasurable risk of late enlargement due to middle meningeal artery (MMA) lesions. Patients with EDHs need to stay hospitalized for several days, with neurological supervision and repeated CT scans. In this study, the a...

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Bibliographic Details
Published in:	Journal of neurosurgery Vol. 128; no. 4; pp. 1044 - 1050
Main Authors:	Peres, Carlos Michel A, Caldas, Jose Guilherme M P, Puglia, Paulo, de Andrade, Almir F, da Silva, Igor A F, Teixeira, Manoel J, Figueiredo, Eberval G
Format:	Journal Article
Language:	English
Published:	United States 01-04-2018
Subjects:	Accidents, Traffic Acute Disease Adolescent Adult Aged Cerebral Angiography Child Cohort Studies Craniocerebral Trauma - complications Embolization, Therapeutic Endovascular Procedures - methods Female Glasgow Coma Scale Hematoma, Epidural, Cranial - diagnostic imaging Hematoma, Epidural, Cranial - etiology Hematoma, Epidural, Cranial - surgery Humans Length of Stay Male Meningeal Arteries - diagnostic imaging Meningeal Arteries - surgery Middle Aged Tomography, X-Ray Computed Treatment Outcome Young Adult OphA = ophthalmic artery TBI = traumatic brain injury EDH = epidural hematoma SAH = subarachnoid hemorrhage embolization NBCA = N-butyl-2-cyanoacrylate AVF = arteriovenous fistula pseudoaneurysm traumatic brain injury middle meningeal artery endovascular treatment vascular disorders PVA = polyvinyl alcohol epidural hematoma GCS = Glasgow Coma Scale MMA = middle meningeal artery SDH = subdural hematoma
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Summary:	OBJECTIVE Small acute epidural hematomas (EDHs) treated conservatively carry a nonmeasurable risk of late enlargement due to middle meningeal artery (MMA) lesions. Patients with EDHs need to stay hospitalized for several days, with neurological supervision and repeated CT scans. In this study, the authors analyzed the safety and efficacy of the embolization of the involved MMA and associated lesions. METHODS The study group consisted of 80 consecutive patients harboring small- to medium-sized EDHs treated by MMA embolization between January 2010 and December 2014. A literature review cohort was used as a control group. RESULTS The causes of head injury were falls, traffic-related accidents (including car, motorcycle, and pedestrian vs vehicle accidents), and assaults. The EDH topography was mainly temporal (lateral or pole). Active contrast leaking from the MMA was seen in 57.5%; arteriovenous fistulas between the MMA and diploic veins were seen in 10%; and MMA pseudoaneurysms were found in 13.6% of the cases. Embolizations were performed under local anesthesia in 80% of the cases, with N-butyl-2-cyanoacrylate, polyvinyl alcohol particles, or gelatin sponge (or a combination of these), obtaining MMA occlusion and complete resolution of the vascular lesions. All patients underwent follow-up CT scans between 1 and 7 days after the embolization. In the 80 cases in this series, no increase in size of the EDH was observed and the clinical evolution was uneventful, without Glasgow Coma Scale score modification after embolization and with no need for surgical evacuation. In contrast, the control cohort from the literature consisted of 471 patients, 82 (17.4%) of whom shifted from conservative treatment to surgical evacuation. CONCLUSIONS This study suggests that MMA embolization is a highly effective and safe method to achieve size stabilization in nonsurgically treated acute EDHs.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-3085 1933-0693
DOI:	10.3171/2016.11.JNS161398