Hemophilia A is an inherited genetic disease with a lack of coagulation factor VIII (FVIII). Although the life expectancy since the introduction of factor substitution in 1960s tremendously improved, possible complications are still dreaded. Muscle bleedings are with 30 % of all bleeds the second most common bleeding location after the joint (Fernandez-Palazzi F et al., Clinical orthopaedics and related research 1996; 328: 19–24). These bleedings can involve especially the quadriceps, iliopsoas and arm muscles. Approximately 12 % of patients with hemophilia A develop an iliopsoas bleed which is considered as a potentially life-threatening event. Initial symptoms of muscle hemorrhage are very similar to joint bleedings with pain, swelling and restrictions in the range of motion. Hence, in the first instance it may be difficult to differentiate between joint and muscle bleed. Over time, patients with muscle bleed can present with chronic pain, nerve compression, compartment syndrome, contracture of the joints, anemia, and recurrent bleedings (Ashrani A et al., Haemophilia 2003; 6: 721– 726). The muscle bleedings can evolve to a large size because of less limiting surrounding, unlike the articular capsule in hemarthrosis. Furthermore, hemorrhagic pseudotumors can arise because of ongoing bloody oozing. The prevalence of pseudotumors in patients with hemophilia is approximately 1–3 %, independently of the severity of hemophilia (Magallón M et al., American journal of hematology 1994; 2: 103–108).

✓The often extended and elongated configuration of a diffuse subdural hematoma of the spine makes it impossible to completely evacuate with common neurosurgical approaches. The authors describe the complete evacuation of a diffuse subdural hematoma of the entire spine due to trauma in a patient who suffered myelopathy and paraplegia in succession, by using transient subdural catheter lysis. After the patient underwent a partial hemilaminectomy at T7–8 and L2–3 using a lateral transmuscular approach, a 15 cm-long intraventricular catheter was inserted at each hemilaminectomy site and connected to an external ventricular drainage system in a procedure lasting 1 hour. Subsequently, 5000 IU of urokinase was applied four times daily for 30 minutes each time over the next 5 days. Two months later, the patient presented with spastic paraparesis Manual Muscle Test Grade 4/5. Magnetic resonance (MR) imaging revealed no catheter-related complications. The authors conclude from this case that transient catheter lysis may be an effective and gentle method to treat diffuse and elongated subdural hematomas of the spine due to trauma. A larger series needs to be analyzed, however, to address the indications and limitations of the technique compared with conventional open surgery. Such evaluation should include serial MR imaging and electrophysiological examination.