[1]刘成云,杨华,徐源,等.复合手术治疗急性进展性硬膜外血肿1例[J].中国临床神经外科杂志,2024,29(05):318-320.[doi:10.13798/j.issn.1009-153X.2024.05.017]
　LIU Cheng-yun,YANG Hua,XU Yuan,et al.Hybrid surgery for a patient with an acute progressive extraparenchymal hematoma[J].,2024,29(05):318-320.[doi:10.13798/j.issn.1009-153X.2024.05.017]
点击复制

复合手术治疗急性进展性硬膜外血肿1例()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年05期
页码:
318-320
栏目:
个案报道
出版日期:
2024-05-30

文章信息/Info

Title:
Hybrid surgery for a patient with an acute progressive extraparenchymal hematoma
文章编号:
1009-153X（2024）05-0318-03
作者:
刘成云; 杨华; 徐源; 彭瀚; 周兴旺; 向欣
550004贵阳，贵州医科大学附属医院神经外科（刘成云、杨华、徐源、彭瀚、周兴旺、向欣）
Author(s):
LIU Cheng-yun;  YANG Hua;  XU Yuan;  PENG Han;  ZHOU Xing-wang;  XIANG Xin
Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
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
Keywords:
Acute epidural hematoma;  Progressive extraparenchymal hematoma;  Hybrid surgery
分类号:
R 651.1+5; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2024.05.017
文献标志码:
B
摘要:
急性硬膜外血肿是神经外科常见急重症之一，具有起病急、病情发展迅速、致残率高等特点。尽管目前开颅手术及钻孔引流术等常见手术方式能有效清除血肿，但仍有部分病人由于缺乏针对责任血管的处理，导致血肿继续进展、病情恶化。本文报道1例75岁女性，因交通事故致意识障碍3 h入院，颅脑CT示右侧颞顶部急性硬膜外血肿，血肿量约28 ml。拟行介入栓塞控制出血，二期行钻孔引流术。在导管室完成股动脉穿刺后，突发右侧瞳孔渐散大至5 mm，考虑进展性血肿增大导致小脑幕切迹疝形成。立即行Dyna-CT确认血肿迅速扩大，随即行硬通道穿刺血肿，抽吸出65 ml活动性出血；造影见右侧脑膜中动脉后支造影剂外溢，证实其破裂活动性出血，予以Onyx胶栓塞后即刻造影见出血停止。Dyna-CT引导下于右侧颞枕部再次穿刺抽吸出205 ml血液。之后行开颅手术，取右侧颞顶枕部马蹄形切口，铣开约12 cm×10 cm骨窗，清除硬膜外血肿约80 ml；放射状剪开硬膜后，清除硬膜下血肿约20 ml，同时去除骨瓣。术后1 d复查CT示血肿基本清除，未见新发血肿。术后8个月随访，GCS评分15分，右侧肢体肌力Ⅴ级，左上肢肌力0级，左下肢肌力Ⅲ级。因此，对于急性硬膜外血肿，应准确判断血肿的部位、性质、出血来源和进展速度，充分了解各种治疗方法的优缺点，及时选择恰当的治疗方法，制定个体化的治疗方案，才能获得良好的治疗结果。
Abstract:
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.

参考文献/References:

[1]ZHANG Y, LI Q, ZHAO R, et al. Novel minimally invasive treatment strategy for acute traumatic epidural hematoma: endovascular embolization combined with drainage surgery and use of urokinase [J]. World Neurosurg, 2018, 110: 206-209.
[2]FAN G, WANG H, DING J, et al. Application of absolute alcohol in the treatment of traumatic intracranial hemorrhage via interventional embolization of middle meningeal artery [J]. Front Neurol, 2020, 11: 824.
[3]KANG CY, LU ZF, CHEN YH. Clinical features of twelve children with delayed traumatic epidural hematoma [J]. Pract J Cardiac Cere Pneum Vasc Dis, 2020, 28(2): 85-88. 亢崇仰，陆兆丰，陈悦华. 儿童创伤性迟发性硬膜外血肿12例临床特征分析[J]. 实用心脑肺血管病杂志，2020，28（2）：85-88.
[4]KIM DH, LEE JY, JEON HJ, et al. Intraoperative endovascular embolization of middle meningeal artery and a pseudoaneurysm by using N-butyl 2-cyanoacrylate for hemostasis during operation of acute epidural hemorrhage [J]. Korean J Neurotrauma, 2015, 11(2): 167.
[5]ZUSSMAN BM, GOLDSCHMIDT E, FARAJI AH, et al. Middle meningeal artery embolization for the treatment of an expanding epidural hematoma [J]. World Neurosurg, 2019, 128: 284-286.
[6]PERES CMA, CALDAS JGMP, PUGLIA P, et al. Endovascular management of acute epidural hematomas: clinical experience with 80 cases [J]. J Neurosurg, 2018, 128(4): 1044-1050.
[7]PARK TJ, LEE SP, BAEK J, et al. Middle meningeal artery embolization to treat progressive epidural hematoma: a case report [J]. J Cerebrovasc Endovasc Neurosurg, 2020, 22(1): 20-25.

相似文献/References:

[1]黄弘杰　林晓元　黄　捷.外伤性进展性后颅窝硬膜外血肿的治疗体会[J].中国临床神经外科杂志,2016,(02):111.[doi:10.13798/j.issn.1009-153X.2016.02.019]
[2]王　刚　袁以刚　胡跃云　夏祥新.婴幼儿急性性硬膜外血肿12例治疗体会[J].中国临床神经外科杂志,2015,(04):237.[doi:10.13798/j.issn.1009-153X.2015.04.016]
[3]汪峰,汤厅均,吴小波,等.急性硬膜外血肿术中大出血的危险因素[J].中国临床神经外科杂志,2022,27(12):1001.[doi:10.13798/j.issn.1009-153X.2022.12.014]
[4]桑布,旦增,桑杰,等.高原地区急性进展型硬膜外血肿致脑疝1例[J].中国临床神经外科杂志,2024,29(02):126.[doi:10.13798/j.issn.1009-153X.2024.02.014]
　SANG Bu,DAN Zeng,SANG Jie,et al.Brain herniation caused by acute progressive epidural hematoma in plateau area: a case report[J].,2024,29(05):126.[doi:10.13798/j.issn.1009-153X.2024.02.014]

备注/Memo

备注/Memo:
（2022-09-15收稿，2023-02-17修回）
通信作者：向　欣，Email：xiangxin828@163.com
更新日期/Last Update: 2024-05-30