Outcomes Following Spinal Intradural Hematoma at a Single Institution

Introduction: Intradural hematomas are a rare neurosurgical condition that can cause severe and debilitating neurological deficits most frequently associated with anticoagulation or local trauma. Given the rarity, only a few case reports exist in the current body of literature with varying management approaches and outcomes. Here we aim to present the largest single institutional cohort describing risk factors, management strategies, and outcomes of spinal intradural hematomas.

Methods: This is a retrospective cohort study of all patients who were evaluated by Neurosurgery at the Mayo Clinic for spinal intradural hematoma from 1997-2023. Patients with isolated epidural hematoma and spinal subarachnoid hemorrhage secondary to intracranial pathology were excluded. Anticoagulation/antiplatelet use, trauma, and presence of a tumor were investigated as risk factors. Primary outcomes were neurological exam at discharge and after 6 months follow-up.

Results: There are currently 11 patients that met inclusion criteria and were included in the study. Eight of 11 patients presented with partial or complete loss of motor function. Of these, 2 of 8 (25%) had improved motor exam postoperatively, one of which had full functional recovery. Nine of the 11 patients underwent surgical decompression and hematoma evacuation with or without expansile duraplasty. The greatest risk factors were antiplatelet use (64%), anticoagulation (45%), and trauma (36%); 6 of 11 (55%) patients had greater than 1 risk factor. The most common postoperative complication was secondary intracranial blood products in 4 of 11 (36%) patients ultimately contributing to 2 deaths.

Conclusion : Operative evacuation of intradural hematoma did not significantly improve motor function in patients with moderate to severe motor impairment at the time of presentation but did resolve motor impairment in a patient with mild motor deficits. The risks and benefits of operative management of spinal intradural hematoma should be carefully considered in patients with moderate to severe motor impairment at the time of presentation.