Endovascular treatment of incoercible epistaxis and epidural cerebral hematoma. A case report

Abstract

A young patient with a facial trauma after a road accident was admitted to our department with incoercible epistaxis. A CT scan showed a right pterional acute epidural hematoma (EDH). Angiography demonstrated multiple sources of bleeding of the right sphenopalatine arteries, cause of the epistaxis, and an intracranial leakage of the right middle meningeal artery, responsible for the EDH. The patient immediately underwent embolization of the right internal maxillary artery and right middle meningeal artery. The procedure stopped the epistaxis and no further enlargement of the EDH was observed, avoiding its surgical treatment. Endovascular surgery may be an effective procedure to stop the arterial meningeal bleeding sustaining acute EDH and may be a useful tool in the management of special cases of post traumatic EDH.

Figure 1

Non contrast axial brain CT scan shows the right pterional epidural hematoma (asterisk), 1 cm maximum size, associated with mild right temporal contusion. Air bubbles (arrows), interpeduncular hemorrhage and subdural tentorial blood suffusion (arrowheads) are shown.

Figure 2

Digital subtraction angiography of the right external carotid artery, lateral projection. The microcatheter is positioned in the external carotid artery. Active bleeding or a small pseudoaneurysm is seen around the middle meningeal artery, parietal branch, 7 mm after its origin, supplying the epidural hematoma (arrow). Common trunk of the middle meningeal artery (arrowhead).

Figure 3

Digital subtraction angiography of the right external carotid artery, lateral projection, after selective endovascular embolization. The microcatheter is before the origin of the internal maxillary artery, to perform panoramic control angiography. Compared to fig. 2 no leakage from the middle meningeal artery is observed.

Figure 4

Non contrast axial brain CT shows the right pterional epidural hematoma (asterisk) slightly decreased in size and in density (compare with figure 1). Right temporal contusion. Readsorption of pneumoencephalon and interpeduncular hemorrhage and subdural tentorial blood suffusion.