Middle Meningeal Artery Embolization in Recurrent Chronic Subdural Hematoma Combined with Arachnoid Cyst

Jiin Kang, Kum Whang, Soon-Ki Hong, Jin-Soo Pyen, Sung-Min Cho, Jong-Yeon Kim, So-Hyun Kim, Ji-Woong Oh, Jiin Kang, Kum Whang, Soon-Ki Hong, Jin-Soo Pyen, Sung-Min Cho, Jong-Yeon Kim, So-Hyun Kim, Ji-Woong Oh

Abstract

Chronic subdural hematoma (CSDH) is a collection of old blood and its breakdown products between the surface of the brain parenchyma and the outermost layer called the dura. The most common treatment option for primary CSDH is burr-hole trephination; however, the treatment method for recurrent CSDH is still widely debated. An arachnoid cyst (AC) is a sac filled with cerebrospinal fluid located between the brain or spinal cord and the arachnoid membrane, which is one of the three meninges covering the brain or spinal cord. Although it is rare, the cyst is associated with CSDH in juveniles, and the recurrence rate of CSDH increases in such cases. Much of the literature has supported the preventive role of middle meningeal artery (MMA) embolization in recurrent CSDH. We report a 13-year-old male patient with recurrent CSDH and AC where the early intervention of MMA embolization was proven effective in preventing the further recurrence of CSDH.

Keywords: Arachnoid cysts; Embolization, therapeutic; Hematoma, subdural, chronic; Meningeal arteries; Recurrence.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

FIGURE 1. Initial preoperative and postoperative brain…
FIGURE 1. Initial preoperative and postoperative brain computed tomography (CT). A, B: The CT images show chronic subdural hematoma on right fronto-temporo-parietal and arachnoid cyst with hematoma on right midfossa. C, D: The first postoperative CT shows.
FIGURE 2. A: Recurrent chronic subdural hematoma…
FIGURE 2. A: Recurrent chronic subdural hematoma on right hemisphere. B: The second closed drainage operation was performed. The computed tomography (CT) shows the nearly total hematoma drained out. C: The latest follow-up CT (5 years follow-up).
FIGURE 3. A-C: Middle meningeal artery (MMA)…
FIGURE 3. A-C: Middle meningeal artery (MMA) angiography shows diffuse abnormal vascular stains of distal branches (black circle in C). D: Angiography of post-MMA embolization. Abnormal vascular stain was no longer evident on follow-up angiography.

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