2018 Volume 23 Issue 2 Pages 138-145
Surgical treatment of organized chronic subdural hematoma often requires craniotomy to remove the hematoma, but subsequent postoperative regrowth may occur due to hemorrhage from the outer membrane of the hematoma or dura mater. Middle meningeal artery embolization is known to be effective for preventing the recurrence of refractory chronic subdural hematoma. We report 3 cases of organized chronic subdural hematoma which were successfully treated by middle meningeal artery embolization prior to hematoma removal by craniotomy, resulting in good outcomes. Case 1 was an 81‒year‒old female. Left chronic subdural hematoma was suspected based on CT findings, and burr hole drainage was performed twice, but the hematoma reaccumulated. Middle meningeal artery embolization was performed followed by a third burr hole drainage the following day, but the drainage was not effective, and the hematoma was therefore diagnosed as an organized chronic subdural hematoma. One month later, the hematoma was removed through a craniotomy. Case 2 was an 81‒year‒old male taking aspirin and clopidogrel for ischemic cardiac disease. Bilateral organized chronic subdural hematomas were suspected based on CT findings but, due to the patient’s advanced age, only the left hematoma was treated by burr hole drainage to confirm the diagnosis. The patient was discharged from the hospital, but his symptoms deteriorated. Bilateral middle meningeal artery embolization was performed, and the left hematoma was removed through a craniotomy 5 days later. Case 3 was a 77‒year‒old male. Left organized chronic subdural hematoma was suspected based on CT findings, and burr hole drainage was performed to confirm the diagnosis. One week later, regrowth occurred, and middle meningeal artery embolization was performed followed the next day by craniotomy to remove the hematoma. None of these 3 patients developed recurrence after craniotomy. Middle meningeal artery embolization followed by hematoma removal by craniotomy can prevent postoperative reaccumulation of organized chronic subdural hematoma.
