Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature

Abstract

Purpose: Although several strategies against recurrent chronic subdural hematoma (CSDH) have been proposed, no consensus has been established. Recently, middle meningeal artery (MMA) embolization has been proposed as radical treatment for recurrent CSDH. We wanted to estimate the usefulness of MMA embolization for recurrent CSDH.

Methods: From February 2012 to June 2013, 110 patients with CSDH underwent single burr-hole surgery with irrigation and drainage. Among these patients, 13 showed recurrent hematoma formation and were retreated surgically. Furthermore, repeated recurrence of CSDH was observed in six patients. Five of these six patients underwent middle meningeal artery (MMA) embolization with polyvinyl alcohol particles. All five patients with interventional treatment were observed for four to 60 weeks.

Results: No more recurrence of CSDH was observed in any of the patients. During the follow-up period, no patients suffered from any side effects or complications from the interventional treatment.

Conclusion: MMA embolization with careful attention paid to the procedure might be a treatment of choice for recurrent CSDH.

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

© The Author(s) 2015.

Figures

Figure 1.

Lateral fluoroscopy image during endovascular intervention in case 4. Selective right MMA angiography was performed at preembolization (a) and post-embolization (b). MMA: middle meningeal artery.

Figure 2.

Head CT scans of case 4 at the second recurrence of CSDH. Pre-interventional (a) and post-interventional (b) CT scans. CT: computed tomography; CSDH: chronic subdural hematoma.