Kadono Yoshinori, Kajikawa Ryuichiro, Tsuzuki Takashi, Kishima Haruhiko
Department of Neurosurgery, Takatsuki General Hospital, Takatsuki, Osaka, Japan.
Department of Neurosurgery, Sakai City Medical Center, Sakai, Osaka, Japan.
Radiol Case Rep. 2024 Sep 25;19(12):6328-6332. doi: 10.1016/j.radcr.2024.09.062. eCollection 2024 Dec.
Organized chronic subdural hematoma (OCSDH) is a rare condition lacking standardized treatment protocols. Middle meningeal artery (MMA) embolization has recently demonstrated promising outcomes in managing chronic subdural hematoma (CSDH). We present 2 cases of OCSDH treated with endovascular embolization and minimal evacuation surgery. The first case involved an 83-year-old male with a history of left CSDH drainage, admitted urgently due to right hemiplegia and dysarthria. CT scans confirmed recurrent CSDH. A small craniotomy was performed to decompress the thick hematoma, followed by drain placement. Postoperative magnetic resonance imaging (MRI) indicated OCSDH. Seven days later, MMA embolization with 25% n-butyl-2-cyanoacrylate (NBCA) was performed under local anesthesia. The patient's symptoms improved, and the hematoma resolved within 6 months without recurrence. The second case involved a 76-year-old male with right CSDH and thrombocytopenia (platelet count of 19,000/µL), diagnosed with immune thrombocytopenia. MRI indicated OCSDH. Due to the risk associated with craniotomy, a burr hole perforation and MMA embolization were planned, accompanied by a platelet transfusion. Left MMA embolization with 20% NBCA was performed, followed by burr hole enlargement for decompression and drain placement. The patient's symptoms improved postoperatively, and his platelet count stabilized with steroid therapy and thrombopoietin. The hematoma resolved within 3 months without recurrence. These cases indicate that MMA embolization combined with small craniotomy or perforation may be an effective treatment strategy for OCSDH.
有组织的慢性硬膜下血肿（OCSDH）是一种罕见疾病，缺乏标准化治疗方案。脑膜中动脉（MMA）栓塞术最近在治疗慢性硬膜下血肿（CSDH）方面显示出良好效果。我们报告2例采用血管内栓塞术和微创引流手术治疗的OCSDH病例。第一例为一名83岁男性，有左侧CSDH引流病史，因右侧偏瘫和构音障碍紧急入院。CT扫描证实为复发性CSDH。行小骨窗开颅术以减压增厚的血肿，随后放置引流管。术后磁共振成像（MRI）显示为OCSDH。7天后，在局部麻醉下用25%的正丁基-2-氰基丙烯酸酯（NBCA）进行MMA栓塞。患者症状改善，血肿在6个月内消退且无复发。第二例为一名76岁男性，患有右侧CSDH和血小板减少症（血小板计数为19,000/µL），诊断为免疫性血小板减少症。MRI显示为OCSDH。由于开颅手术存在风险，计划行钻孔穿刺和MMA栓塞，并输注血小板。用20%的NBCA对左侧MMA进行栓塞，随后扩大钻孔以减压并放置引流管。患者术后症状改善，其血小板计数通过类固醇治疗和血小板生成素得以稳定。血肿在3个月内消退且无复发。这些病例表明，MMA栓塞联合小骨窗开颅术或穿刺术可能是治疗OCSDH的有效策略。
