Yokoya Shigeomi, Nishii Sho, Takezawa Hidesato, Katsumori Tetsuya, Takagi Yasufumi, Goto Yukihiro, Oka Hideki, Shiomi Naoto, Hino Akihiko
Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan.
Department of Neurology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan.
Asian J Neurosurg. 2020 Apr 7;15(2):421-424. doi: 10.4103/ajns.AJNS_341_19. eCollection 2020 Apr-Jun.
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.
有包膜的慢性硬膜下血肿（OSDH）的最佳治疗方法仍存在争议。尽管据报道大骨瓣开颅术对于治疗OSDH是必要且有效的，但开颅术会伴有术后出血并发症和复发。尽管据报道脑膜中动脉（MMA）栓塞术对于难治性慢性硬膜下血肿（CSDH）有效，但其对OSDH的疗效仍不明确。我们报告了2例OSDH患者，先采用MMA栓塞术治疗，然后在局部麻醉下通过小骨瓣开颅术清除血肿，病情进展良好。病例1：一名71岁男性因CSDH接受了单孔冲洗治疗，但因血肿质地坚硬而失败。他在接受MMA栓塞术后在局部麻醉下进行了小骨瓣开颅术。开颅术中，观察到血肿及其外膜有少量出血。术后，症状立即消失，血肿未复发。病例2：一名77岁男性接受了钻孔冲洗，但由于OSDH血肿未被清除，且仍存在运动性失语。在接受MMA栓塞术后，在局部麻醉下进行了开颅术。术中出血极少，开颅术后其神经症状改善，无任何复发。MMA栓塞术和小骨瓣开颅清除血肿可能是OSDH的一种治疗选择。
