Patel Saarang, Hoglund Zachary, Palepu Chandrasekhar, Scott Kyle W, Srinivasan Visish M
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Department of Neurosurgery, School of Medicine, St. George's University, Grenada, West Indies.
J Neurol Surg Rep. 2025 May 27;86(2):e116-e121. doi: 10.1055/a-2603-9286. eCollection 2025 Apr.
Middle meningeal artery (MMA) embolization is an emerging intervention for subdural hemorrhage. Few cases discuss the utility of contralateral MMA embolization due to challenging ipsilateral MMA anatomy for this indication.
A 90-year-old male presented after 6 days of slurred speech and severe headache. A head computed tomography (CT) revealed a left-sided 13-mm subdural hemorrhage, and neck CT angiography revealed left internal carotid artery stenosis at 50%. The carotid stenosis was treated with a standard carotid endarterectomy at the carotid bulb. Despite direct catheterization of the external carotid artery, selective catheterization of the MMA was not feasible. Instead, coils were placed in the left internal maxillary artery spanning the left MMA origin, and the right MMA was selectively embolized using a standard transradial approach. Postoperative CT showed a reduction in subdural hematoma (SDH) size, and the patient was discharged in stable condition on postoperative day 6.
This case presents a rescue or salvage maneuver for MMA embolization for SDH with a favorable safety profile and outcome.
脑膜中动脉（MMA）栓塞术是一种用于治疗硬膜下出血的新兴干预措施。由于该适应症同侧MMA解剖结构具有挑战性，很少有病例讨论对侧MMA栓塞术的效用。
一名90岁男性在出现言语含糊和严重头痛6天后就诊。头部计算机断层扫描（CT）显示左侧有13毫米的硬膜下出血，颈部CT血管造影显示左侧颈内动脉狭窄50%。在颈动脉球部对颈动脉狭窄进行了标准的颈动脉内膜切除术治疗。尽管直接对颈外动脉进行了插管，但对MMA进行选择性插管不可行。取而代之的是，将线圈置于跨越左侧MMA起源处的左上颌动脉内，并采用标准的经桡动脉途径对右侧MMA进行选择性栓塞。术后CT显示硬膜下血肿（SDH）大小减小，患者在术后第6天病情稳定出院。
本病例展示了一种用于硬膜下出血的MMA栓塞术的挽救或补救策略，具有良好的安全性和预后。
