Endovascular Treatment Following Gauze Packing for the Control of Massive Bleeding from Traumatic Transverse Sinus Lesion / 대한신경손상학회지

Posterior fossa epidural hematoma (EDH) is uncommon, but the related clinical deterioration can occur suddenly. Accompanying venous sinus injury and lacerations are associated with 40% to 80% mortality. The authors present one clinical case of a patient with posterior fossa EDH from transverse sinus bleeding. A 57-year-old male was injured after falling while working. He was taken to the hospital, where computed tomography scans of his brain revealed a right posterior temporal and cerebellar EDH with a right temporo-occipital fracture. He underwent a right parieto-occipital craniotomy, incorporating the fracture line. Longitudinal laceration of the right transverse sinus extending to the sigmoid sinus with profuse bleeding was identified. Four gauzes were inserted in the epidural space for tamponade of the injured sinus. Conventional angiography and coil embolization for the injured sinus were immediately performed. Subsequently, the patient was transferred to the operating room, wherein staff members removed the gauzes and remnant hematoma. Based on this experience, the authors recommend that for posterior fossa EDH from transverse sinus bleeding, bleeding control should be performed by gauze packing and endovascular treatment.

Acute traumatic bilateral epidural hematomas in children / 中国小儿急救医学

Objective To observe and the clinical characteristics in children with acute traumatic bi-lateral eip dural hematomas,analyze the formation mehc ansi ms and explore the early diagnso is strategies and effective surgical treatment methods.Methods From August 2004 to December 2013,21 cases(17 males,4 females) of pediatric patients with acute traumatic bilateral epidural hematomas were treated in our hospital, and the clinical materials,imaging data and prognosis were summarized and analyzed.Results The 21 pedi-atric patients were aged from 4 months to 16 years,the mean ga e was 6.88 years.Bilateral single epidural hematoma across the superior sagittal sinus was found in 5 cases,bilateral double or more hematomas in both sides of the midline were observed in 16 cases.Initial CT scan showed simultaneous bilateral hematomas in 12 cases;while in 9 cases of bilateral hematomas were found with a delayed onset by the reviewed CT.The admitting glasgow coma score was between 13-15 in 8 cases,9-12 in 11 cases and 3-8 in 2 cases.Surgi-cal treatment was performed in 8 cases,including 7 cases with bilateral operations and 1 case with unilateral operation.Thirteen cases were managed consevr atively.Exec pt one death case, all other children were well er covered to normal lives.Conclusion Delayed contra-lateral epidural hematomas following evacuation of a prior EDH can lead to poor outcome because of usually delayed discovery.Early dynamic CT scans can detect bilateral epidural hematomas and observe their changes in time.Early detectiona nd prompt individual treat-ment should be applied in children with bilateral epidural hematomas to get good prognosis.

Analysis of Risk Factors for the Development of Post-Operative Epidural Hematoma after Intracranial Surgery / 대한신경손상학회지

OBJECTIVE: Patients undergoing intracranial operations often suffer from post-operative epidural hematoma (EDH). The incidence and risk factors for with the occurrence of EDH after intracranial operations are not well described previously. The objective of this study was to identify the risk factors and the incidence of post-operative EDH adjacent and regional to the craniotomy. METHODS: This was a retrospective study of 23 (2.4%) patients, between January 2005 and December 2011, who underwent epidural hematoma evacuation after primary intracranial during this period, 941 intracranial operations were performed. The control group (46 patients) and hematoma group (23 patients) were categorized on the basis of having undergone the same pre-operative diagnosis and treatment within 3 months of their operations. The ages of the hematoma and control group were individually matched to similar ages within 10 years of each other to minimize bias of age. RESULTS: Univariate analysis showed that the significant pre-operative and intra-operative factors associated with post-operative EDH were a pre-operative Glasgow Coma Scale (GCS) scored 1.0 (p=0.014), prothrombin time (PT) >11.3 sec (p=0.008), intra-operative blood loss >650 mL (p=0.003) and craniotomy size >7,420 mm2 (p=0.023). In multivariate analysis, intra-operative blood loss exceeding 650 mL (median of total patients) placed a patient at significantly increased risk for post-operative EDH. CONCLUSION: Recognizing the limitations of the study, large intra-operative blood loss, wide craniotomy area, prolonged PT and a pre-operative GCS <8 are presented implicated with an increased risk of post-operative EDH after intracranial surgery.

Spontaneous Intracranial Epidural Hematoma Following Thoracolumbar Schwannoma Removal

We report a case of spontaneous intracranial epidural hematoma following the intraoperative course of a patient who had undergone surgical removal of a thoracolumbar schwannoma in olivo-ponto-cerebellar atrophy. To our knowledge there is no reported case in which the thoracolumbar schwannoma removal was followed by such a complication. Mechanical events leading to this complication are unclear. Abnormal results of a neurological examination in the early postoperative period should suggest this possibility.