title: Usefulness of Embolization for Iatrogenic Dural Arteriovenous Fistula Associated with Recurrent Chronic Subdural Hematoma: A Case Report and Literature Review.
abstract: BACKGROUND
  Refractory chronic subdural hematomas due to iatrogenic dural arteriovenous fistulas (dAVFs) are difficult to treat. We report our experience and propose a guideline on basis of a literature review for the usefulness of embolization of middle meningeal artery (MMA) for the treatment of the same.
  
  
  METHODS
  We report a case with right hemiparesis and aphasia 1 month after a fall from a bicycle. Computed tomography scan of the head showed left chronic subdural hematoma, which was evacuated by burr-hole drainage. The postoperative course was complicated by reaccumulation within short period of time. On superselective digital subtraction angiography of MMA, iatrogenic dAVF was found on left side. We embolized successfully it using n-butyl cyanoacrylate after a third irrigation. No reaccumulation found in the postoperative period or at last follow-up. We propose treatment protocol based on our experience and literature review.
  
  
  CONCLUSIONS
  Refractory chronic subdural hematoma with reaccumulation within a short interval should be subjected to digital subtraction angiography of the MMA. Embolization of ipsilateral MMA is safe, effective, and a useful option for the treatment of iatrogenic dAVF and resolution of hematoma.
authors.affiliation: Department of Neurosurgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India; Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan.
authors.forename: Tushit
authors.initials: T
authors.lastname: Mewada
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan. Electronic address: tomotaka.oshima@toyota-kai.or.jp.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ohshima
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors.forename: Taiki
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors.forename: Shunsaku
authors.initials: S
authors.lastname: Goto
authors.affiliation: Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kato
mesh_terms: D015901:Angiography, Digital Subtraction; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods*; D020200:Hematoma, Subdural, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D015898:Tomography Scanners, X-Ray Computed
keywords: Dural arteriovenous fistula; Embolization; Subdural hematoma; n-butyl cyanoacrylate (NBCA)