{"id":"de6ae244-0324-4f02-bbf8-3100e169c790","slug":"middle-meningeal-artery-embolization-for-symptomatic-chronic-subdural-hematoma-in-the-setting-of-severe-transfusion-refractory-thrombocytopenia-a-case-study-and-review-of-literature","title":"Middle meningeal artery embolization for symptomatic chronic subdural hematoma in the setting of severe transfusion-refractory thrombocytopenia: A case study and review of literature","authors":["Frances Tiffany Cava Morden","Clark Gianni Caballero","Maveric Abella","Andie Conching","Hannah Gang","Thomas Noh"],"abstract":"Background: Surgical decompression for the treatment of chronic subdural hematomas (cSDHs) is irrefutably effective; however, its utility in managing cSDH in patients with comorbid coagulopathy remains controversial. The optimal threshold for platelet transfusion in cSDH management is 3, according to guidelines from the American Association of Blood Banks GRADE framework. This threshold may be unachievable in refractory thrombocytopenia, though surgical intervention may still be warranted. We present a patient with symptomatic cSDH and transfusion-refractory thrombocytopenia successfully treated with middle meningeal artery embolization (eMMA). We also review the literature to identify management approaches for cSDH with severe thrombocytopenia. Case Description: A 74-year-old male with acute myeloid leukemia presented to the emergency department with persistent headache and emesis following fall without head trauma. Computed tomography (CT) revealed a 12 mm right-sided, mixed density SDH. Platelets were 3 initially, which stabilized to 20,000 following platelet transfusions. He then underwent right eMMA without surgical evacuation. He received intermittent platelet transfusions with platelet goal >20,000 and was discharged on hospital day 24 with resolving SDH on CT. Conclusion: High-risk surgical patients with refractory thrombocytopenia and symptomatic cSDH may be successfully treated with eMMA without surgical evacuation. A platelet goal of 20,000/mm3 before and following surgical intervention proved beneficial for our patient. Similarly, a literature review of seven cases of cSDH with comorbid thrombocytopenia revealed five patients undergoing surgical evacuation following initial medical management. Three cases reported a platelet goal of 20,000. All seven cases resulted in stable or resolving SDH with platelets >20,000 at discharge.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/de6ae244-0324-4f02-bbf8-3100e169c790/featured/hero-1781560211204.png","publishDate":"2023-06-30T00:00:00.000Z","doi":"10.25259/SNI_1051_2022","categories":["Unique Case Observations","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/de6ae244-0324-4f02-bbf8-3100e169c790/pdf"}