Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Neuroradiol J. 2023 Oct;36(5):625-629. doi: 10.1177/19714009221150857. Epub 2023 Jan 24.
Middle meningeal artery (MMA) embolization is commonly performed as either a first-line or adjunct treatment for chronic subdural hematomas (cSDH). We present the case of a 59 year-old male patient who presented with right hemibody weakness and cognitive impairment and was diagnosed with left-sided cSDH. A left MMA embolization was performed due to the recurrent nature of the chronic subdural hemorrhage and the history of prior craniotomy. On postoperative day 1, the patient developed sudden onset left facial swelling and tenderness, and a contrast computed tomography (CT) of the neck revealed acute ischemia in the left parotid gland, adjacent superior aspect of the left masseter muscle, the left lateral pterygoid, and left temporalis muscles. The patient was treated conservatively with antibiotics, steroids, and analgesics and reported resolution of symptoms on the three-month follow-up. To our knowledge, this is the first reported case of the ipsilateral parotid gland, temporalis muscle, adjacent superior aspect of the masseter muscle, and pterygoid muscle ischemia secondary to non-target particle embolization following MMA embolization in cSDH. Knowledge of normal and variant origin of the MMA and various anastomoses of this vessel with branches of the internal carotid artery (ICA), external carotid artery (ECA), and vertebrobasilar system is crucial to avoid complications during embolization.
脑膜中动脉（MMA）栓塞术通常作为慢性硬膜下血肿（cSDH）的一线或辅助治疗方法。我们报告了一例 59 岁男性患者，因右侧半身无力和认知障碍就诊，被诊断为左侧 cSDH。由于慢性硬膜下血肿的复发性和先前开颅手术的病史，对左侧 MMA 进行了栓塞。术后第 1 天，患者出现左侧面部肿胀和压痛，颈部对比 CT 显示左侧腮腺、左侧咬肌上缘、左侧翼内肌和左侧颞肌急性缺血。患者接受了抗生素、类固醇和止痛药的保守治疗，并在三个月的随访中报告症状缓解。据我们所知，这是首例报告的 cSDH 患者，在 MMA 栓塞术后，由于非靶粒子栓塞，同侧腮腺、颞肌、咬肌上缘和翼内肌缺血。了解 MMA 的正常和变异起源以及该血管与颈内动脉（ICA）、颈外动脉（ECA）和椎基底动脉系统分支的各种吻合至关重要，可避免栓塞过程中的并发症。
