HEMATOMA EVACUATION

What is a Hematoma Evacuation?

The term ‘Hematoma Evacuation’ refers to the removal of a hematoma. This involves surgical drainage of accumulated blood from localized areas in the body. A hematoma generally refers to the collection or pooling of blood outside of blood vessels. Most hematomas come about through injuries to the wall of any type of blood vessel (arteries, veins, or capillaries). This injury allows blood to ooze out of the blood vessel and into surrounding tissues.  

Hematomas may occur in different forms in the human body. This condition may show up as purplish bruises under the skin or as a lump large enough to feel. Hematomas may also occur deep in certain parts of the body without visibility.

What are the Types of Hematomas?

Generally, the location of a hematoma determines the type of the hematoma. The main types of hematomas include:

Epidural Hematoma

This type of hematoma occurs when a blood vessel ruptures between the brain and the outer lining of the skull. Major trauma to a blood vessel occurs as the most common cause of epidural hematoma.

Subdural Hematoma

This type of hematoma occurs when a blood vessel ruptures between the inside lining of the brain and the brain tissue. Subdural hematomas usually occur after severe head injuries and may turn fatal in cases where the hematoma keeps on enlarging.

Intracerebral Hematoma

Intracerebral hematomas occur when blood accumulates in the tissues of the brain. This type of hematoma may come about due to trauma, tumors, high blood pressure, or rupture of a bulging blood vessel.

Other types of hematomas based on their location include:

Subungual Hematoma: a hematoma that occurs under the nails

Aural Hematoma: a hematoma that occurs between the cartilage of the ear and the skin

Spinal Epidural Hematoma: a hematoma between the lining of the vertebrae and the spinal cord

Intra-abdominal Hematoma: a hematoma within the abdominal cavity

Hepatic Hematoma: a hematoma that occurs within the liver

What are the Causes of Hematomas?

The primary cause of a hematoma remains trauma or damage to blood vessels. Any form of trauma or damage to a blood vessel can lead to hematoma, especially in older adults and individuals that take blood-thinning medication. Severe traumas that occur as a result of motor vehicle accidents or head injuries can lead to more severe hematomas. Intake of certain blood-thinning medications may increase the risk of a hematoma formation. These medications may include aspirin and aspirin-containing drugs, vitamin E, NSAIDs such as ibuprofen, and garlic supplements. Rarely, a hematoma may occur without any specific trauma or identifiable cause.

How do Neurosurgeons Diagnose Hematomas?

Diagnosis of a hematoma typically involves physical examination along with a detailed medical history. A neurosurgeon may recommend some diagnostic tests to confirm the presence of a hematoma.  These tests which also determine the location and size of the hematoma include a CT scan of the head, an MRI scan, and an angiogram.

What does Recovery from a Hematoma Evacuation look like?

Total recovery after hematoma evacuation surgery ranges from a few weeks to six months depending on the type of hematoma and the patient’s medical history. Hematoma evacuation surgeries usually do not possess severe complications after the surgery. Physical therapy may prove necessary in cases where neurological problems persist after the total recovery time.

References 

Zimmerman, L. H. (2007). Causes and consequences of critical bleeding and mechanisms of blood coagulation. Pharmacotherapy, 27(9, pt 2), 45S–56S.

Traumatic brain injury: Hope through research. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Traumatic-Brain-Injury-Hope-Through. Accessed March 23, 2017

McBride W. Subdural hematoma in adults: Etiology, clinical features, and diagnosis. https://www.uptodate.com/home. Accessed March 23, 2017.

McBride W. Intracranial epidural hematoma in adults. https://www.uptodate.com/home. Accessed March 23, 2017

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