Efficacy of middle meningeal artery embolization in the treatment of refractory chronic subdural hematoma

Masaki Mino, Shinjitsu Nishimura, Emiko Hori, Misaki Kohama, Shingo Yonezawa, Hiroshi Midorikawa, Mitsuomi Kaimori, Teruhiko Tanaka, Michiaharu Nishijima, Masaki Mino, Shinjitsu Nishimura, Emiko Hori, Misaki Kohama, Shingo Yonezawa, Hiroshi Midorikawa, Mitsuomi Kaimori, Teruhiko Tanaka, Michiaharu Nishijima

Abstract

Background: There are no established treatment procedures for repeatedly recurring chronic subdural hematoma (CSH). In this study, we discussed the efficacy of middle meningeal artery (MMA) embolization in preventing recurrence of CSH.

Methods: We performed superselective angiography of MMA in four patients who suffered from repeated recurrence of CSH. After angiography, we performed embolization of MMA with endovascular procedure.

Results: In all cases, superselective angiography of MMA revealed diffuse abnormal vascular stains that seemed to represent the macrocapillaries in the outer membrane of CSH. In all the patients, there were no recurrences or enlargements of CSH after the embolization of the MMA.

Conclusion: MMA embolization can be an effective adjuvant procedure in preventing the recurrence of CSH.

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

Figures

Figure 1
Figure 1
CT images of case 1. (A) CT scan on admission showing bilateral CSH. (B) CT scan 3 months after first surgery, showing recurrence of left CSH. (C) CT scan 2 months after second surgery, showing recurrence of left CSH
Figure 2
Figure 2
CT images of case 2. (A) CT scan on admission showing right CSH. (B) CT scan 1 day after the surgery, showing a bleeding between the dura mater and the outer membrane. (C) CT scan after the craniotomy. (D) CT scan 2 weeks after the craniotomy, showing an increase in right subdural hematoma
Figure 3
Figure 3
MRI and CT images of case 3. (A) MRI on admission showing left CSH. (B) CT scan after irrigation and drainage. (C) CT scan 13 days after the surgery, showing recurrence of left CSH
Figure 4
Figure 4
CT images of case 4. (A) CT scan on admission, showing bilateral CSH. (B) CT scan 1 day after the surgery, showing a new hemorrhage in the left side of hematoma cavity. (C) CT scan 2 weeks after the surgery, showing an increase in left subdural hematoma
Figure 5
Figure 5
Superselective angiography of MMA (lateral view, ipsilateral side of the recurrent CSH) in cases 1 to 4 (A-D), showing diffuse abnormal vascular stains around the branches of MMA
Figure 6
Figure 6
CT image of case 2 obtained after the MMA angiography procedure, showing leakage of contrast enhancement into the hematoma cavity

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