Open AccessOrganized chronic subdural hematoma treated with middle meningeal artery embolization and small craniotomy: Two case reports
Author(s) -
Shigeomi Yokoya,
Sho Nishii,
Hidesato Takezawa,
Tetsuya Katsumori,
Yasufumi Takagi,
Yukihiro Goto,
Hideki Oka,
Naoto Shiomi,
Akihiko Hino
Publication year - 2020
Publication title -
asian journal of neurosurgery
Language(s) - English
Resource type - Journals
ISSN - 1793-5482
DOI - 10.4103/ajns.ajns_341_19
Subject(s) - medicine , craniotomy , hematoma , embolization , middle meningeal artery , surgery , anesthesia , subdural hemorrhage , chronic subdural hematoma
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.