How is hematoma outside dural handled

In principle, the treatment of acute epidural hematoma should be performed immediately after diagnosis to eliminate the hematoma to relieve intracranial hypertension, and appropriate non-surgical treatment should be given after surgery according to the condition. Yiprajna had a good prognosis without other serious complications and mild primary brain injury. The mortality rate ranges from 10% to 25%, with wide variations by region or unit. In fact, the main cause of death in such patients is not hematoma itself, but secondary damage to the brain stem caused by the formation of cerebral hernia. Therefore, early diagnosis and timely treatment are necessary to effectively reduce mortality. 1) Surgical treatment: Bone window craniotomy or bone flap craniotomy is usually used to facilitate the complete removal of hematoma, sufficient hemostasis and subdural exploration when necessary, which is a long-used surgical method for epidural hematoma. In recent years, due to the wide application of CT scan, the location, size and brain injury of hematoma are well known, and the changes of hematoma can be dynamically observed. Therefore, some authors have successfully used skull drilling to drain epidural hematoma. ① Bone window craniotomy for epidural hematoma removal: it is suitable for patients who are in critical condition and have cerebral hernia without imaging diagnosis and positioning, and are directly sent to the operating room for rescue. Drilling exploration is carried out first, and then the hematoma is removed by expanding bone window. The sequence of drilling should be near the fracture line of the large temporal pupil, and about 60% ~ 70% of the epidural hematoma can be found. After the hematoma was detected, the incision was extended as needed, the bone ligature was enlarged, the hematoma was expelled, and hemostasis was properly performed. If the dural tension is still high after removal of hematoma, or swollen or blue, it should be opened to explore, so as not to miss the subdural or intracerebral hematoma. After the operation, the scalp was sutured in layers with an epidural rubber drainage strip. The skull defect was left to be repaired after 2 ~ 3 months. ② Bone flap craniotomy for epidural hematoma removal: it is suitable for cases with clear hematoma location. Based on the imaging findings, craniotomy was performed. There is no need to exhumate the hematoma after exposure. Therefore, the cranial pressure has been quite relieved. In order to reduce bleeding, the hematoma can be gradually stripped from the periphery to the thickest part of the hematoma near the base of the skull, and the ruptured dura arteries and veins can be found, and electric coagulation or suture ligature can be given. After the hematoma is cleared, it is appropriate to wash the wound with normal saline, carefully examine whether there are bleeding points, and stop one by one to prevent postoperative bleeding. If the dural tension is high or subdural hematoma is suspected, the dural should be opened for exploration, and the operation should not be hastily ended by removing the bone flap and decompression. Notice, missing hematoma is one of the most important causes of postoperative death. After the operation, the dura mater was suspended at the edge of the bone window, the bone flap was reduced, the scalp was sutured in layers, and the epidural drainage was performed for 24-48 hours. ③ Drilling and puncturing to remove epidural hematoma: it is suitable for emergency rescue of especially acute epidural hematoma. In order to temporarily relieve intracranial hypertension and gain time, the first cone hole or drilling to discharge part of liquid hematoma. This emergency measure has been used for pre-hospital emergency or drainage of intracerebral hematoma. Recently, there are scholars for the treatment of acute epidural hematoma, to achieve rapid drainage hematoma rescue patients. The indications are relatively stable condition, blood loss of about 30-50ml, clear location by CT examination, midline displacement of more than 0.5cm, no continuous bleeding. Methods Conical holes or drilling holes were made at the thickest part of the hematoma as shown by CT, and then suction tube was inserted or crushed suction tube with silk was put in. Part of the blood was drained and then injected with urokinase, or urokinase plus hyaluronidase to dissolve the remaining blood clots, repeated for several times. Catheter drainage was kept for 3-6 days until the hematoma had been drained to a certain extent in CT examination. 2) Non-surgical treatment: acute epidural hematoma should be treated with timely and reasonable non-surgical treatment regardless of operation, especially for patients with severe primary brain injury and/or secondary brain injury, which should not be taken lightly. The conservative treatment of epidural hematoma: apply to clear mind, condition balance; CT examination hematoma measurement is less than 40ml, midline displacement is less than 1.5cm; Deterioration of unconsciousness, edema of fundus and appearance of new symptoms; Non middle fossa or posterior fossa hematoma. The treatment measures should be on the premise of closely observing the clinical manifestations of patients, using dehydration, hormones, hemostasis and drugs to promote blood circulation and remove stasis, such as salvia miltiorrhiza, chuanxiong, etc., and using CT for dynamic monitoring, so as to ensure safety.

If you have any questions, please contact us. Our company can produce various customized needles, medical needles, puncture needles, hypodermic needles, biopsy needles, vaccine needles, injection needles, syringe needles, veterinary needles, pencil point needle, ovum pick up needles, spinal needles, etc. If you need customized needle products, please contact us. We look forward to your inquiry! The quality of the products manufactured in our factory will surely satisfy you!

Please contact us if you need: zhang@sz-manners.com