Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas
The patient was a 68-year-old female who had been treated for cerebral infarction and pulmonary embolism with oral warfarin. She had no history of head bruises. She visited our hospital with a chief complaint of disorientation. Head CT showed left-sided CSDH [], and left-sided burr hole irrigation of the hematoma was performed []. Because of the high risks associated with discontinuation of warfarin, she was followed up with continuation of the oral administration. Although CT performed 1 month later showed only slight changes of density [], head CT performed 2 months later showed a slight enlargement of the hematoma and increased density []. These findings were considered as signs of recurrence, and embolization of the middle MMA was performed.\nEmbolization\nA 6F guiding catheter was inserted from the right femoral artery and placed in the left external carotid artery. A microcatheter was advanced into the left MMA. Subsequently, angiography was performed, which showed cotton wool-like staining []. The microcatheter was further advanced to the frontal branch. Twenty per cent NBCA was injected after confirmation of the negative result of a provocative test with 1% lidocaine injection. The parietal branch was also embolized with 20% NBCA in a similar procedure.\nPostoperative course\nThe hematoma started to decrease in size 1 week after embolization [] and disappeared in 4 months [].\nNo recurrence has been observed since then.