Overcoming refractory subgaleal hematoma with endovascular treatment - A novel therapeutic approach

Sep 28, 2026

Uploaded by McQueen

Subgaleal hematoma (SGH) is a rare adult condition usually linked to trauma and often inadequately managed by conventional strategies such as aspiration and simple compression. A 37-year-old woman with recurrent SGH despite conservative therapy underwent endovascular treatment consisting of selective coil embolization of feeding vessels followed by percutaneous aspiration and compression dressing. The procedure yielded minimal improvement and prevented recurrence. The case supports EVT as a less invasive alternative to surgical incision and drainage with potentially favorable longer-term outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Subgaleal hematoma background and causes

Limitations of traditional treatments

Case description

Initial presentation and conservative management

Recurrence and diagnostic workup

Treatment decision and endovascular therapy

Procedure and imaging overview

Case Report Journal of Cerebrovascular Endovascular Neurosurgery and Journal of Cerebrovascular and Endovascular Neurosurgery pISSN 2234-8565, eISSN 2287-3139, [https://doi.org/10.7461/jcen.2025.E2024.11.001](https://doi.org/10.7461/jcen.2025.E2024.11.001) Overcoming refractory subgaleal hematoma with endovascular treatment: A novel therapeutic approach Bong-Gyu Ryu, Yongjae Lee, Dae Han Choi Department of Neurosurgery, Chamjoeun Hospital, Gwangju-si, Gyeonggi-do, Republic of Korea J Cerebrovasc Endovasc Neurosurg. 2025 December;27(4):362-367 Received: 23 October 2024 Revised: 23 June 2025 Accepted: 25 June 2025 Correspondence to Bong-Gyu Ryu Department of Neurosurgery, Chamjoeun Hospital, 45, Gwangju-daero, Gwangju-si, Gyeonggi-do, Korea Tel +82-31-881-9355 Fax +82-31-881-9177 E-mail [neurosurgeryryu@gmail.com](neurosurgeryryu@gmail.com) ORCID [https://orcid.org/0000-0002-3125-5212](https://orcid.org/0000-0002-3125-5212) Subgaleal hematoma (SGH) is a rare condition in adults, typically resulting from trauma. It has primarily been treated with traditional methods, such as aspiration and needle puncture. However, Conventional treatments, such as simple compression dressingsand needle aspiration, have been found inadequate in addressing refractory SGH. To overcome these challenges, we performed endovascular treatment (EVT), involving selective coil embolization of the vessels feeding the hematoma, followed by percutaneous hematoma aspiration and compression dressing. In this case report, a 37-year-old female patient with head trauma developed a recurrent subgaleal hematoma despite conservative treatments. Endovascular treatment was performed, resulting insignificant improvement and no recurrence. This case suggests that EVT provides a viable and effective treatment alternative for adult patients with refractory SGH, offering a less invasive approach compared to surgical incision and drainage, with promising long-term outcomes. Keywords Hematoma, Endovascular procedures, Embolization, Adult, Head trauma This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc/4.0/](by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. INTRODUCTION Subgaleal hematoma (SGH) results from injury to the emissary veins, leading to blood accumulation in the subgaleal space between the galea aponeurotica and the pericranium.15)19) SGH is primarily reported in neonates,8) and only a small number of cases have been documented in adolescents and adults.3)6) While SGH is mainly associated with trauma and hair pulling,25) other causes such as arteriovenous fistulas (AVF),4) arteriovenous malformations (AVM),12)17) and coagulation disorders11)14) should be considered in the differential diagnosis.23) The key characteristics of SGH—“Seeping blood from vein”,“blood-soaked galea”and “inability to self-tamponade”—make treatment with traditional methods (simple compression and aspiration) difficult and lead to frequent recurrences.16) This report describes a case of successful endovascular treatment for an adult SGH 362 [www.the-jcen.org](www.the-jcen.org) Copyright © 2025 by KSCVS and KoNES that was refractory to conventional therapy. CASE DESCRIPTION This case report reviews the treatment of a 37-year-old female patient who presented with SGH following ahead trauma. The patient received treatment in June 2024 at our institution. The report focuses on the clinical course, imaging findings, and the endovascular treatment (EVT) procedure performed. The study was approved by the Institutional Review Board (IRB) of Kyung Hee University Hospital at Gangdong (approval number: KHNMC 2024-10-007). Due to the retrospective nature of this

FAQs

Why are conventional treatments often insufficient for refractory adult subgaleal hematoma?

Conventional methods like simple compression and aspiration can be difficult to sustain because of SGH characteristics such as persistent bleeding and inability to self-tamponade, leading to frequent recurrences.

What endovascular treatment steps were used in this case?

Endovascular treatment involved selective coil embolization of vessels feeding the hematoma, followed by percutaneous hematoma aspiration and compression dressing.

What evidence supported the diagnosis and recurrence workup in this report?

After recurrence, coagulation studies showed no abnormalities, and CT angiography was performed to rule out aneurysm, arteriovenous fistula, and arteriovenous malformation, revealing engorged vessels forming a reticular network around the hematoma.

Sep 28, 2026

Uploaded by McQueen