Yamauchi Yutaka, Kuramoto Satoshi, Ikeda Akito, Yabuno Satoru, Takahashi Yu, Nishihiro Shingo, Ono Yasuhiro, Ichikawa Tomotsugu
Department of Neurological Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.
NMC Case Rep J. 2024 Oct 24;11:291-296. doi: 10.2176/jns-nmc.2024-0138. eCollection 2024.
Chronic subdural hematoma (CSDH) in posterior fossa is rare, and its pathogenesis and treatment remain unclear. In this study, we report a case of a patient with CSDH in the posterior fossa who was taking warfarin and underwent middle meningeal artery (MMA) embolization successfully. A 59-year-old man taking warfarin for a mechanical aortic valve presented with a complaint of hearing impairment. He then developed headaches and was referred to our hospital after the previous physician identified CSDH above and below the left tentorium cerebelli on computed tomography (CT). We conducted MMA embolization with n-butyl-2-cyanoacrylate while continuing anticoagulation therapy. Right after the day of the surgery, symptoms of hearing impairment and right hemiplegia immediately improved. He was discharged after 10 days of hospitalization and was able to walk independently. His symptoms disappeared 20 days after surgery. There was no recurrence 100 days after surgery. In this study, we experienced a case of a CSDH in the posterior fossa that was clinically improved by MMA embolization. MMA embolization is a useful option for nonspecific CSDH without interruption of warfarin therapy.
后颅窝慢性硬膜下血肿（CSDH）较为罕见，其发病机制及治疗方法仍不明确。在本研究中，我们报告了一例服用华法林的后颅窝CSDH患者，该患者成功接受了脑膜中动脉（MMA）栓塞术。一名59岁男性因机械主动脉瓣置换术后服用华法林，出现听力减退症状。随后他出现头痛，在之前的医生通过计算机断层扫描（CT）发现左侧小脑幕上下均有CSDH后，转诊至我院。我们在继续抗凝治疗的同时，使用正丁基-2-氰基丙烯酸酯进行了MMA栓塞术。术后当天，听力减退和右侧偏瘫症状立即改善。住院10天后出院，能够独立行走。术后20天症状消失。术后百日无复发。在本研究中，我们遇到一例后颅窝CSDH患者，通过MMA栓塞术临床症状得到改善。MMA栓塞术是一种在不中断华法林治疗的情况下，治疗非特异性CSDH的有效选择。
