Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas
The patient was a 79-year-old male who had been receiving chemotherapy since he was diagnosed with peritoneal mesothelioma. He visited a neighborhood hospital when he experienced a fall and received a hard blow to the back of the head. One month later, his follow-up head computed tomography (CT) showed a thin right-sided CSDH, and he was prescribed oral administration of ibudilast and was followed up. Because hematoma enlargement was observed 4 months later [], right-sided burr hole irrigation was performed []. However, mild left hemiparesis occurred 3 months later. Head CT performed subsequently showed recurrence. Burr hole irrigation was repeated, resulting in the resolution of the left hemiparesis. Because of further recurrence in the following month [], a third burr hole irrigation was performed []. Subsequently, embolization of the MMA was scheduled.\nEmbolization\nEmbolization of the MMA was performed 6 days after the third burr hole irrigation of the hematoma.\nA 6F guiding catheter was inserted from the left femoral artery and placed in the right external carotid artery. A microcatheter was advanced into the parietal branch of the right MMA. Subsequently, angiography was performed, which showed cotton wool-like staining []. Sixteen per cent NBCA was injected after confirmation of the negative result of a provocative test with 1% lidocaine injection. The frontal branch was also embolized with 16% NBCA in a similar procedure.\nPostoperative course\nThe right subdural space was observed to gradually decrease in size. There was no sign of recurrence during the first month after embolization []. Although some traces were seen on head CT images taken 3 months later, the hematoma had almost disappeared [].\nNo recurrence has been observed since then.