title: Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas.
abstract: BACKGROUND
  Chronic subdural hematoma (CSDH) is generally treated by burr hole irrigation. However, sometimes repeated recurrence is observed, and treatment may consequently become difficult. We examined the efficacy of embolization of the middle meningeal artery (MMA) for such cases.
  
  
  METHODS
  We considered embolization of the MMA for three patients who had refractory CSDH with repeated recurrence and two CSDH patients who were at risk of recurrence and showed signs of recurrence after surgery. A microcatheter was advanced through the MMA as peripherally as possible, and embolization was performed with 15-20% n-butyl-2-cyanoacrylate or 200 μm polyvinyl alcohol particles.
  
  
  RESULTS
  EMBOLIZATION WAS PERFORMED IN THE THREE PATIENTS WHO HAD REFRACTORY CSDH WITH REPEATED RECURRENCE: The procedure was performed after burr hole irrigation of the hematoma in two patients and before the irrigation in one patient. In the two CSDH patients at risk of recurrence, embolization was performed when signs of recurrence appeared. The timing of embolization differed for each patient. However, in all the patients, the hematoma tended to decrease in size, and no recurrence was observed.
  
  
  CONCLUSIONS
  Embolization of the MMA is effective for refractory CSDH or CSDH patients with a risk of recurrence, and is considered an effective therapeutic method to stop hematoma enlargement and promote resolution.
authors.affiliation: Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjyuku Shinjyukuku Tokyo 160-0023, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Tomoo
authors.initials: T
authors.lastname: Ohashi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Watanabe
authors.forename: Syunichi
authors.initials: S
authors.lastname: Koyama
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Namatame
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Izawa
authors.forename: Rei
authors.initials: R
authors.lastname: Haraoka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Okada
authors.forename: Norio
authors.initials: N
authors.lastname: Ichimasu
authors.forename: Jiro
authors.initials: J
authors.lastname: Akimoto
authors.forename: Jo
authors.initials: J
authors.lastname: Haraoka
keywords: Chronic subdural hematoma; embolization; middle meningeal artery; recurrence
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