Middle meningeal artery embolization for chronic subdural hematoma with cerebrospinal fluid hypovolemia: A report of 2 cases - 26/03/21

Doi : 10.1016/j.neuchi.2021.02.008

Y. Okuma ^a,^b,⁎ , N. Hirotsune ^b, Y. Sotome ^b, Y. Kegoya ^b, Y. Matsuda ^b, Y. Sato ^b, Y. Tomita ^b, T. Tanabe ^b, K. Muraoka ^b, S. Nishino ^b, S. Daido ^a
^a Department of Neurological Surgery, Fukuyama City Hospital, Fukuyama, Japan
^b Department of Neurological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

^⁎Corresponding author. Department of Neurological Surgery, Fukuyama City Hospital, 5-23-1 Zao-cho, 721-8511 Fukuyama, Hiroshima, Japan.Department of Neurological Surgery, Fukuyama City Hospital5-23-1 Zao-choFukuyama, Hiroshima721-8511Japan

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 26 March 2021
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

Chronic subdural hematoma (CSDH) with cerebrospinal fluid hypovolemia syndrome (CHS) remains refractory to standard treatment with hematoma drainage by burr hole and irrigation and/or epidural blood patch. Previously, we reported the utility of middle meningeal artery (MMA) embolization for intractable CSDH. In this study, we present the usefulness of MMA embolization as a treatment for CSDHs with CHSs.

Cases

We present two cases of CSDHs with CHSs occurring in patients, 1 treated with burr hole craniotomy and irrigation, and the other treated with the epidural blood patch. Both patients exhibited similar-appearing bilateral relatively-thin hematomas, hyperplasia, and enhanced contrast effects in the dura mater, and extradural hygroma in the cervical portion on enhanced magnetic resonance imaging scans. Also, to reviewing prior literature and imaging findings, they had already undergone conventional treatment. We added MMA embolization treatment and they followed a good course.

Results

Despite the known intractable outcomes of patients with CSDHs with CHSs, MMA embolization worked well in the current case series.

Conclusion

MMA embolization might be considered as a preferred therapeutic option for CSDHs with CHSs in order to buy time before the epidural blood patch starts working.

Le texte complet de cet article est disponible en PDF.

Keywords : Chronic subdural hematoma, Cerebrospinal fluid hypovolemia syndrome, Middle meningeal artery embolization, Epidural physiologic saline continuous injection, Epidural blood patch.