Embolization of the Middle Meningeal Artery for Refractory Chronic Subdural Haematoma. Usefulness for Patients under Anticoagulant Therapy

Abstract

Endovascular embolization of the middle meningeal artery was performed in two cases of refractory chronic subdural haematoma (CSDH) after repeated burr hole and irrigation surgeries. The embolization prevented expansion of the CSDH in both cases, and the haematoma disappeared completely in one case. The expansion of CSDH is considered to result from repeated bleeding from the macrocapillaries on the haematoma capsule. Embolization of the middle meningeal artery appears to be useful to eliminate the blood supply to this structure.

Figures

Figure 1

Preoperative (A) and postoperative (B) CT scans in Case 1. Bilateral subdural haematoma is noted even after the burr hole irrigation surgery.

Figure 2

Superselective angiogram of the right middle meningeal artery, lateral projection. Abnormal vascular networks are demonstrated along this artery.

Figure 3

Preoperative (A) and postoperative (B) CT scans in Case 2. A subdural haematoma is noted in the right frontoparietal area with the midline shift, even after the burr hole irrigation surgery.

Figure 4

Superselective angiogram of the right middle meningeal artery, lateral projection. Abnormal vascular networks are demonstrated along the enlarged middle meningeal artery.

Figure 5

CT scan after the embolization of the middle meningeal artery. The right subdural haematoma decreased in volume and its density.