Revisión de 22 casos de hematomas epidurales espinales. Factores pronósticos y manejo terapéutico
Spinal epidural hematomas. Prognostic factors in a series of 22 cases and a proposal for management
A. Torres
, J.J. Acebes, J. Cabiol, A. Gabarros, L. López, G. Plans, P. Teixidor
Servicio de Neurocirugía. Hospital Universitario de Bellvitge. Barcelona
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"apellidos" => "Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.J." "apellidos" => "Acebes" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Cabiol" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Gabarros" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "López" ] 5 => array:2 [ "nombre" => "G." "apellidos" => "Plans" ] 6 => array:2 [ "nombre" => "P." "apellidos" => "Teixidor" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurocirugía. Hospital Universitario de Bellvitge. Barcelona" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Servicio de Neurocirugía. Hospital Universitario de Bellvirge. Feixa Llarga, s/n. 08907 L’Hospitalet de Llobregat. Barcelona." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Spinal epidural hematomas. Prognostic factors in a series of 22 cases and a proposal for management" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2003-10-21" "fechaAceptado" => "2004-01-19" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec158495" "palabras" => array:4 [ 0 => "Compresión medular" 1 => "Hematoma epidural espinal" 2 => "Intervalo quirúrgico" 3 => "Evolución final" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec158496" "palabras" => array:4 [ 0 => "Spinal cord compression" 1 => "Spinal epidural hematoma" 2 => "Surgical timing" 3 => "Final outcome" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El hematoma epidural espinal (HEE) es una patología poco frecuente, causante de compresión medular aguda, clásicamente considerada como una urgencia quirúrgica. Recientemente se ha propuesto el tratamiento conservador cuando existe afectación neurológica leve, con buenos resultados funcionales finales.</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Determinar los factores pronósticos de esta entidad y proponer un manejo terapéutico.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Entre 1985 y 2001 han sido tratados, en el Servicio de Neurocirugía del Hospital Universitario de Bellvitge (HUB), 22 pacientes diagnosticados de HEE. Se han analizado una serie de variables: edad, sexo, déficit neurológico inicial (según la Escala de Frankel), tiempo de evolución hasta el tratamiento, así como la localización, extensión y grado de compresión medular radiológica. La toma de medicación anticoagulante o antiagregante, la existencia de anestesia epidural o cirugía espinal previa fueron, asimismo, factores tomados en consideración para el análisis final.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se ha recogido el tipo de tratamiento (médico o quirúrgico) y se han evaluado las secuelas, así como el grado de afectación neurológica final.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La serie se compone de 22 pacientes, con un 72.7% de varones y una mediana de edad es de 69 años. El tratamiento quirúrgico se practicó en 17 casos, la mayoría de los cuales (11 casos) presentaban un déficit neurológico grave (Frankel A-B). Se realizó tratamiento conservador en 5 pacientes, la mayoría (4 de 5) presentaban afectación neurológica leve (Frankel D). Los pacientes intervenidos presentaron mayor grado de mejoría de su déficit neurológico inicial. El índice de complicaciones post-quirúrgicas fue del 13%.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El tratamiento quirúrgico precoz (primeras 24 horas) mejora el pronóstico en los pacientes que presentan afectación neurológica, especialmente de grado severo (Frankel A-B). Los pacientes asintomáticos o con afectación neurológica leve (Frankel D-E) pueden ser tratados inicialmente de forma conservadora.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Spontaneous and non-spontaneous spinal epidural hematoma (SEH) is a rare condition in neurosurgical practice. It presents as an acute spinal cord compression and usually requires emergent sur-gical decompression. Recently non-surgical treatment (corticoid therapy) has been proposed in selected cases of SEH with good neurological recovery.</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To identify the prognostic factors of this condition. A treatment management based upon our results is proposed.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Between 1985 and 2001, 22 patients suffering SEH were treated at our Department. Age, sex, initial neurological condition (evaluated using the Frankel grading scale), surgical timing, radiological data such as location, extension and degree of radiological cord compression, anticoagulation or antiplatelet therapy, epidural anesthesia and previous spinal surgery were analyzed in order to find prognostic factors. Finally, conservative or surgical treatment as well as final neurological condition were also considered for the analysis.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The average age was 69 years with a male preponderance (72.7%). Surgical decompression was done in 17 cases, most of them (11 cases) presenting with high neurological deficit (Frankel A-B). Conservative treatment was used on 5 patients. Operated patients showed a larger degree of neurological recovery. The incidence of post-operative complications was of 13%.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">This study shows the efficiency of SEH surgical evacuation performed within the flrst 24 hours, particularly when the patient presents a severe neurological deficit (Frankel A-B). Patients presenting minimal neurological involvement (Frankel D-E) can be mana-ged succesfully with conservative treatment.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Torres, A.; Cabiol, J.; Gabarros, A.; Teixidor, P.; Plans, G.; López, L.; Acebes, J. J.: Revisión de 22 casos de hematomas epidurales espinales. Factores pronósticos y manejo terapéutico. Neurocirugía 2004; 15: 353–359.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous spinal epidural haematoma with spontaneous resolution" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Brawn" 1 => "U. Bergval" 2 => "G. 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