- Department of Neurosurgery, Aomori Prefectural Central Hospital, 2-1-1 Higashitsukurimichi, Aomori 030-8553, Japan
- Department of Radiology, Aomori Prefectural Central Hospital, 2-1-1 Higashitsukurimichi, Aomori 030-8553, Japan
- Department of Clinical Laboratory, Aomori Prefectural Central Hospital, 2-1-1 Higashitsukurimichi, Aomori 030-8553, Japan
Department of Neurosurgery, Aomori Prefectural Central Hospital, 2-1-1 Higashitsukurimichi, Aomori 030-8553, Japan
DOI:10.4103/2152-7806.73801© 2010 Mino M This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Mino M, Nishimura S, Hori E, Kohama M, Yonezawa S, Midorikawa H, Kaimori M, Tanaka T, Nishijima M. Efficacy of middle meningeal artery embolization in the treatment of refractory chronic subdural hematoma. Surg Neurol Int 13-Dec-2010;1:78
How to cite this URL: Mino M, Nishimura S, Hori E, Kohama M, Yonezawa S, Midorikawa H, Kaimori M, Tanaka T, Nishijima M. Efficacy of middle meningeal artery embolization in the treatment of refractory chronic subdural hematoma. Surg Neurol Int 13-Dec-2010;1:78. Available from: http://sni.wpengine.com/surgicalint_articles/efficacy-of-middle-meningeal-artery-embolization-in-the-treatment-of-refractory-chronic-subdural-hematoma/
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
Single-burr-hole surgery (closed-system drainage or irrigation with or without drainage) has been established as an effective procedure for the treatment of chronic subdural hematoma (CSH).[
Between January 2007 and December 2008, 75 patients with CSH underwent single-burr-hole surgery, closed-system drainage, or irrigation of the hematoma cavity. Among these patients, four patients (5.3%) showed repeated recurrences of CSH or progressive reaccumulation of the fluid in a short period.
The first patient (case 1) was a 73-year-old man who presented with gait disturbance. He had suffered a fall accident 1 month before admission. The computed tomography (CT) images revealed bilateral CSH [
The second patient (case 2) was a 79-year-old man without any history of trauma. The patient presented with speech disturbance and dementia, and CT scan revealed right CSH [
The third patient (case 3) was a 65-year-old man who presented with right hemiparesis. He had suffered a fall accident 1 month before admission. The magnetic resonance images revealed left CSH [
The fourth patient (case 4) was a 75-year-old man who presented with gait disturbance. He had been involved in a motorcycle accident 1 month before admission. The CT image revealed bilateral CSH [
In these four cases, superselective angiography was performed using a microcatheter that was inserted into the MMA, ipsilateral to the recurrent CSH. After angiography, MMA was embolized in the endovascular procedure with gelatin sponge and Guglielmi detachable coils.
In all the four cases, superselective angiography of MMA revealed diffuse abnormal vascular stains around the branches of MMA, which seemed to represent the macrocapillaries in the outer membrane of CSH [
Two patients (the first and the third patient) underwent further drainage within 24 hours after embolization, and two patients were observed without any surgical treatment. All the patients were observed for more than 6 months after the embolization of MMA, and there was no recurrence or enlargement of CSH. In the two patients who were conservatively observed after embolization, the rest of the CSH gradually reduced.
In the literature, the recurrence rate of CSH has been reported to be approximately 10%.[
Tanaka et al.[
MMA embolization for the treatment of CSH was first reported by Mandai et al. in 2000,[
Because CSH is more frequent in elder patients, repeated surgery can be invasive and torturous for the patient. MMA embolization has been established as a less-invasive procedure for the treatment of meningiomas or dural A-V shunts.
Surgery is still the appropriate form of treatment for CSH; however, MMA embolization can be an effective adjuvant procedure to prevent or delay the recurrence of CSH.
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