Senol Yigit Can, Asghariahmadabad Mona, Cooke Daniel L, Savastano Luis E
Department of Neurological Surgery, University of California, San Francisco, CA, USA.
Department of Radiology, University of California, San Francisco, CA, USA.
Interv Neuroradiol. 2024 Dec 11:15910199241267342. doi: 10.1177/15910199241267342.
Middle meningeal artery embolization (MMAe) is rapidly emerging as a valuable intervention to decrease the risk of recurrent subdural hematoma (SDH) after surgical evacuation. The role of upfront bilateral MMAe for unilateral SDH and the value of contralateral MMAe after SDH recurrence post evacuation and ipsilateral MMAe are still unknown. Here, we report the case of an elderly patient that presented with a large acute on chronic SDH and underwent surgical drainage and ipsilateral MMAe (with Contour PVA particles, 150-250 µm). At one month follow-up, he was found to have a significant radiographic recurrence of the SDH with interval acute hemorrhage. Angiography revealed complete occlusion of the trunk of the previously embolized ipsilateral MMA, and the presence of robust anastomotic branches from the contralateral MMA crossing the midline to collateralize patent distal branches of the previously embolized MMA. Decision was made to proceed with contralateral MMAe, which resulted in near complete SDH resolution at 6 months follow-up.
脑膜中动脉栓塞术（MMAe）正迅速成为一种有价值的干预措施，以降低手术清除术后复发性硬膜下血肿（SDH）的风险。对于单侧SDH，术前双侧MMAe的作用以及在SDH清除术后复发且同侧MMAe后对侧MMAe的价值仍不清楚。在此，我们报告一例老年患者，该患者患有大量慢性硬膜下血肿急性发作，接受了手术引流和同侧MMAe（使用Contour PVA颗粒，150 - 250 µm）。在1个月的随访中，发现他的SDH有明显的影像学复发并伴有间歇性急性出血。血管造影显示先前栓塞的同侧MMA主干完全闭塞，且对侧MMA有强大的吻合支穿过中线，为先前栓塞的MMA的远端分支提供侧支循环。决定进行对侧MMAe，在6个月的随访中SDH几乎完全消退。
