A Case of Refractory Chronic Subdural Hematoma Treated by Repeated Middle Meningeal Artery Embolization. The Difference between Embosphere and n-butyl-2-cyanoacrylate (NBCA)

Abstract

Objective: We investigated the efficacy of Embosphere and n-butyl-2-cyanoacrylate (NBCA) in the middle meningeal artery (MMA) embolization for refractory chronic subdural hematoma (CSDH).

Case presentation: A 65-year-old man underwent MMA embolization with Embosphere (300–500 μm) for left-sided refractory organized CSDH followed by craniotomy for hematoma removal. Histologic examination showed that Embosphere did not infiltrate into the outer membrane. The hematoma increased again about 6 weeks after craniotomy. The second angiography revealed the collateral blood flow from the right MMA to the left-sided hematoma membrane. We performed the right MMA embolization using NBCA. There were no further recurrences after embolization with NBCA.

Conclusion: Embosphere (300–500 μm) was too large to infiltrate into the outer membrane of CSDH. So smaller particles and liquid embolic agents are considered to be more effective. Involvement of contralateral MMA should be investigated in MMA embolization for refractory CSDH.