Experience in endovascular treatment of recurrent chronic subdural hematoma

Abstract

Most cases with chronic subdural hematoma (CSDH) are treated by simple irrigation and drainage, then more than eighty percent of them result in good recovery. But we sometimes encounter intractable cases with hematoma re-collection, which is considered of repeated bleeding from macrocapillary in the hematoma capsule. Embolization of the middle meningeal artery (MMA) is considered to be useful to eliminate the blood supply to this structure. The authors experienced seven cases of intractable CSDH treated by MMA embolization and no recurrence took place in all cases for up to 15 months. Endovascular treatment may be a good alternative modality for recurrent CSDH.

Figures

Figure 1

Preembolization CT scans of the presenting case. Preoperative (A) and postoperative (B) CT scans at first drainage. Hematoma is evacuated. Preoperative (C) and postoperative(D) CT scans at second drainage. Preoperative (E) and postoperative(F) CT scans at third drainage. Third recurrence in spite of repeated burr hole surgery.

Figure 2

Left external carotid artery angiography (ECAG) (A,B,C). Left superselective MMA angiography (D,E,F). Abnormal vascular networks are demonstrated especially at the late artery phase (arrow, arrow head).

Figure 3

A) Superselective angiogram of the left MMA, lateral projection. 20%NBCA injected into MMA: started from peripheral branch of MMA, sliding back to proximal trunk. B) Lateral view of skull X-ray shows NBCA cast (arrow head). C) Left ECAG after the embolization of the MMA. The MMA is completely embolized and the abnormal vascular network is no longer seen.

Figure 4

A) CT scan three months after embolization showed noted decrease of hematoma. B) CT scan 16 months after embolization demonstrated almost complete resolusion of the hematoma.