Surgical Management of Recurrent Spontaneous Spinal Epidural Hematoma With 3 Episodes

Study design. A case report. Objective. We report a case of spontaneous spinal epidural hematoma with 3 bleeding episodes and discuss the surgical management of recurrent spontaneous spinal epidural hematoma. Summary of Background Data. Spontaneous spinal epidural hematoma is a rare condition that causes spinal cord compression and neurological deficits. However, the cause of bleeding remains unclear and recurrent bleeding is very seldom reported. Methods. A 39-year-old female patient was referred to Kyoto University hospital with sudden back and right upper extremity pain. She was also treated conservatively at the local hospital 19 and 4 months previously because of same episodes. Magnetic resonance images demonstrated right spinal epidural hematoma at the C6–T1 level. In the first 2 episodes, magnetic resonance images revealed spinal epidural hematomas at exactly the same level. Results. In the third episode, the patient's neurological condition was not worse than it had been in the first 2 episodes, and we initially managed her conservatively. To identify the cause of the hematoma, surgery was performed 15 days after the third onset. Microscopic examination revealed the development of a venous plexus around the old hematoma in the dorsal epidural space. The patient was discharged without any further neurological deficits, and recurrent bleeding has not occurred for 6 months after surgery. Conclusion. This is the first report of operative and histological observation of recurrent spontaneous spinal epidural hematoma caused by a posterior venous plexus. In a case of recurrent spontaneous spinal epidural hematoma, surgery might be necessary to prevent further hematomas. Level of Evidence: N/A

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