Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 421-424
DOI: 10.4103/ajns.AJNS_341_19
Case Report

Organized chronic subdural hematoma treated with middle meningeal artery embolization and small craniotomy: Two case reports

Shigeomi Yokoya
Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga
,
Sho Nishii
Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga
,
Hidesato Takezawa
1   Department of Neurology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga
,
Tetsuya Katsumori
2   Department of Radiology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga
,
Yasufumi Takagi
Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga
,
Yukihiro Goto
Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga
,
Hideki Oka
Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga
,
Naoto Shiomi
Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga
,
Akihiko Hino
Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

The most preferred treatment for organized chronic subdural hematoma (OSDH) remains controversial. Although a large craniotomy has been reported to be necessary and effective for the treatment of an OSDH, a craniotomy is associated with postoperative hemorrhagic complications and recurrence. Although middle meningeal artery (MMA) embolization has been reported to be effective for a refractory chronic subdural hematoma (CSDH), its efficacy for an OSDH remains unclear. We report two cases of OSDH treated with MMA embolization followed by hematoma removal via a small craniotomy under local anesthesia with good progress. Case 1: A 71-year-old man underwent a single burr hole irrigation for a CSDH, which failed due to a solid hematoma. He underwent a small craniotomy under local anesthesia after an MMA embolization. During the craniotomy, a small hemorrhage from the hematoma and its outer membrane was observed. Postoperatively, the symptoms disappeared immediately, and the hematoma did not recur. Case 2: A 77-year-old man underwent a burr hole irrigation, but the hematoma was not evacuated because of an OSDH, and he remained in motor aphasia. After an MMA embolization, a craniotomy was performed under local anesthesia. Intraoperative hemorrhage was minimal, and after the craniotomy, his neurological symptoms improved without any recurrence. MMA embolization and hematoma removal with a small craniotomy could be a treatment option for an OSDH.

Key-words:

Craniotomy - embolization - middle meningeal artery - organized chronic subdural hematoma

Financial support and sponsorship

Nil.




Publication History

Received: 18 November 2019

Accepted: 19 January 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Balevi M. Organized chronic subdural hematomas treated by large craniotomy with extended membranectomy as the initial treatment. Asian J Neurosurg 2017;12:598-604.
  • 2 Callovini GM, Bolognini A, Callovini G, Gammone V. Primary enlarged craniotomy in organized chronic subdural hematomas. Neurol Med Chir (Tokyo) 2014;54:349-56.
  • 3 Hayashi S, Nishimoto Y, Nonakla M, Higuchi S, Hosoda K, Miki T, et al. Craniotomy following middle meningeal artery embolization for organized chronic subdural hematoma: Three case reports. Neurosurg Emerg 2018;23:138-45.
  • 4 Chihara H, Imamura H, Ogura T, Adachi H, Imai Y, Sakai N. Recurrence of a refractory chronic subdural hematoma after middle meningeal artery embolization that required craniotomy. NMC Case Rep J 2014;1:1-5.
  • 5 Kim E. Embolization therapy for refractory hemorrhage in patients with chronic subdural hematomas. World Neurosurg 2017;101:520-7.
  • 6 Tempaku A, Yamauchi S, Ikeda H, Tsubota N, Furukawa H, Maeda D, et al. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature. Interv Neuroradiol 2015;21:366-71.
  • 7 Waqas M, Vakhari K, Weimer PV, Hashmi E, Davies JM, Siddiqui AH. Safety and effectiveness of embolization for chronic subdural hematoma: Systematic review and case series. World Neurosurg 2019;126:228-36.
  • 8 Shim YS, Park CO, Hyun DK, Park HC, Yoon SH. What are the causative factors for a slow, progressive enlargement of a chronic subdural hematoma? Yonsei Med J 2007;48:210-7.
  • 9 Mandai S, Sakurai M, Matsumoto Y. Middle meningeal artery embolization for refractory chronic subdural hematoma. Case report. J Neurosurg 2000;93:686-8.
  • 10 Fujioka M, Okuchi K, Miyamoto S, Sakaki T, Tsunoda S, Iwasaki S. Bilateral organized chronic subdural haematomas: High field magnetic resonance images and histological considerations. Acta Neurochir (Wien) 1994;131:265-9.
  • 11 Ohkawa T, Ogura M, Tanaka S, Terada T, Itakura T. Craniotomy for organized subdural hematoma. No Shinkei Geka 2005;33:357-62.
  • 12 Fukazawa K, Sakakura M, Niwa S, Yamamoto J, Kuraishi K, Mouri G. A case of organized chronic subdural hematoma showing an early recurrence after craniotomy. No Shinkei Geka 2005;33:389-94.
  • 13 Isobe N, Sato H, Murakami T, Kurokawa Y, Seyama G, Oki S. Six cases of organized chronic subdural hematoma. No Shinkei Geka 2008;36:1115-20.