Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas

Takao Hashimoto, Tomoo Ohashi, Daisuke Watanabe, Syunichi Koyama, Hiroaki Namatame, Hitoshi Izawa, Rei Haraoka, Hirofumi Okada, Norio Ichimasu, Jiro Akimoto, Jo Haraoka, Takao Hashimoto, Tomoo Ohashi, Daisuke Watanabe, Syunichi Koyama, Hiroaki Namatame, Hitoshi Izawa, Rei Haraoka, Hirofumi Okada, Norio Ichimasu, Jiro Akimoto, Jo Haraoka

Abstract

Background: Chronic subdural hematoma (CSDH) is generally treated by burr hole irrigation. However, sometimes repeated recurrence is observed, and treatment may consequently become difficult. We examined the efficacy of embolization of the middle meningeal artery (MMA) for such cases.

Methods: We considered embolization of the MMA for three patients who had refractory CSDH with repeated recurrence and two CSDH patients who were at risk of recurrence and showed signs of recurrence after surgery. A microcatheter was advanced through the MMA as peripherally as possible, and embolization was performed with 15-20% n-butyl-2-cyanoacrylate or 200 μm polyvinyl alcohol particles.

Results: EMBOLIZATION WAS PERFORMED IN THE THREE PATIENTS WHO HAD REFRACTORY CSDH WITH REPEATED RECURRENCE: The procedure was performed after burr hole irrigation of the hematoma in two patients and before the irrigation in one patient. In the two CSDH patients at risk of recurrence, embolization was performed when signs of recurrence appeared. The timing of embolization differed for each patient. However, in all the patients, the hematoma tended to decrease in size, and no recurrence was observed.

Conclusion: Embolization of the MMA is effective for refractory CSDH or CSDH patients with a risk of recurrence, and is considered an effective therapeutic method to stop hematoma enlargement and promote resolution.

Keywords: Chronic subdural hematoma; embolization; middle meningeal artery; recurrence.

Figures

Figure 1
Figure 1
(a) CT scan on admission showing the right CSDH. (b) CT scan after the first irrigation. (c) CT scan 1 month after the second irrigation, showing re-recurrence of right CSDH. (d) CT scan after the third irrigation
Figure 2
Figure 2
Superselective angiography of the right MMA. Abnormal vascular networks are seen (arrows)
Figure 3
Figure 3
(a) CT scan 1 month and (b) 3 months after embolization of the MMA showed a decrease in the size of the right CSDH
Figure 4
Figure 4
(a) Initial CT scan showing left CSDH and (b) CT scan after irrigation
Figure 5
Figure 5
(a) CT scan 1 month after irrigation demonstrated slight density change and (b) 2 months after irrigation, the left CSDH slightly increased in size and its density increased greatly
Figure 6
Figure 6
Superselective angiography of the left MMA. Abnormal vascular networks are seen (arrow)
Figure 7
Figure 7
(a) CT scan 1 week after embolization of the MMA showed a decrease in the size of the left CSDH and (b) 4 months after embolization, the left CSDH disappeared.

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