Korean J Neurotrauma.  2015 Oct;11(2):187-190. 10.13004/kjnt.2015.11.2.187.

Middle Meningeal Artery Embolization in Recurrent Chronic Subdural Hematoma Combined with Arachnoid Cyst

• Kang J
• Whang K
• Hong SK
• Pyen JS
• Cho SM
• Kim JY
• Kim SH
• Oh JW

• KMID: 2378285
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.187

Abstract

Chronic subdural hematoma (CSDH) is a collection of old blood and its breakdown products between the surface of the brain parenchyma and the outermost layer called the dura. The most common treatment option for primary CSDH is burr-hole trephination; however, the treatment method for recurrent CSDH is still widely debated. An arachnoid cyst (AC) is a sac filled with cerebrospinal fluid located between the brain or spinal cord and the arachnoid membrane, which is one of the three meninges covering the brain or spinal cord. Although it is rare, the cyst is associated with CSDH in juveniles, and the recurrence rate of CSDH increases in such cases. Much of the literature has supported the preventive role of middle meningeal artery (MMA) embolization in recurrent CSDH. We report a 13-year-old male patient with recurrent CSDH and AC where the early intervention of MMA embolization was proven effective in preventing the further recurrence of CSDH.

Keyword

Hematoma, subdural, chronic; Recurrence; Arachnoid cysts; Embolization, therapeutic; Meningeal arteries

MeSH Terms

Adolescent
Arachnoid Cysts
Arachnoid*
Brain
Cerebrospinal Fluid
Early Intervention (Education)
Embolization, Therapeutic
Hematoma, Subdural, Chronic*
Humans
Male
Membranes
Meningeal Arteries*
Meninges
Recurrence
Spinal Cord
Trephining

Figure

• 

  FIGURE 1 Initial preoperative and postoperative brain computed tomography (CT). A, B: The CT images show chronic subdural hematoma on right fronto-temporo-parietal and arachnoid cyst with hematoma on right midfossa. C, D: The first postoperative CT shows.

• 

  FIGURE 2 A: Recurrent chronic subdural hematoma on right hemisphere. B: The second closed drainage operation was performed. The computed tomography (CT) shows the nearly total hematoma drained out. C: The latest follow-up CT (5 years follow-up).

• 

  FIGURE 3 A-C: Middle meningeal artery (MMA) angiography shows diffuse abnormal vascular stains of distal branches (black circle in C). D: Angiography of post-MMA embolization. Abnormal vascular stain was no longer evident on follow-up angiography.

Reference

1. Chan JY, Huang CT, Liu YK, Lin CP, Huang JS. Chronic subdural hematoma associated with arachnoid cyst in young adults: a case report. Kaohsiung J Med Sci. 2008; 24:41–44. PMID: 18218569.

2. Han SB, Choi SW, Song SH, Youm JY, Koh HS, Kim SH, et al. Prediction of Chronic Subdural Hematoma in Minor Head Trauma Patients. Korean J Neurotrauma. 2014; 10:106–111.

3. Kertmen H, Gürer B, Yilmaz ER, Sekerci Z. Chronic subdural hematoma associated with an arachnoid cyst in a juvenile taekwondo athlete: a case report and review of the literature. Pediatr Neurosurg. 2012; 48:55–58. PMID: 22832284.

4. Kushida Y, Terao H, Shibata I, Shishido M, Seiki Y, Tsutsumi S. [Chronic subdural hematoma associated with arachnoid cyst--study of the mechanism of its development]. No Shinkei Geka. 1983; 11:1211–1217. PMID: 6664448.

5. Kwak YS, Hwang SK, Park SH, Park JY. Chronic subdural hematoma associated with the middle fossa arachnoid cyst: pathogenesis and review of its management. Childs Nerv Syst. 2013; 29:77–82. PMID: 22914923.

6. Laumer R. Implantation of a reservoir for refractory chronic subdural hematoma. Neurosurgery. 2002; 50:672. PMID: 11841742.

7. Mandai S, Sakurai M, Matsumoto Y. Middle meningeal artery embolization for refractory chronic subdural hematoma. Case report. J Neurosurg. 2000; 93:686–688. PMID: 11014549.

8. Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg. 1981; 54:637–645. PMID: 7014792.

9. Mino M, Nishimura S, Hori E, Kohama M, Yonezawa S, Midorikawa H, et al. Efficacy of middle meningeal artery embolization in the treatment of refractory chronic subdural hematoma. Surg Neurol Int. 2010; 1:78. PMID: 21206540.

10. Mondorf Y, Abu-Owaimer M, Gaab MR, Oertel JM. Chronic subdural hematoma--craniotomy versus burr hole trepanation. Br J Neurosurg. 2009; 23:612–616. PMID: 19922275.

11. Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 2001; 41:371–381. PMID: 11561347.

12. Mori K, Yamamoto T, Horinaka N, Maeda M. Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst. J Neurotrauma. 2002; 19:1017–1027. PMID: 12482115.

13. Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg. 2001; 95:256–262. PMID: 11780895.

14. Page A, Paxton RM, Mohan D. A reappraisal of the relationship between arachnoid cysts of the middle fossa and chronic subdural haematoma. J Neurol Neurosurg Psychiatry. 1987; 50:1001–1007. PMID: 3655804.

15. Reddy RD. Intracranial arachnoid cysts. Neurol India. 2013; 61:1–2. PMID: 23466830.

16. Regan JM, Worley E, Shelburne C, Pullarkat R, Watson JC. Burr hole washout versus craniotomy for chronic subdural hematoma: patient outcome and cost analysis. PLoS One. 2015; 10:e0115085. PMID: 25611468.

17. Robinson RG. Congenital cysts of the brain: arachnoid malformations. Prog Neurol Surg. 1971; 4:133–174.

18. Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol. 1997; 47:418–422. PMID: 9131021.

19. Sato M, Iwatsuki K, Akiyama C, Kumura E, Yoshimine T. Implantation of a reservoir for refractory chronic subdural hematoma. Neurosurgery. 2001; 48:1297–1301. PMID: 11383733.

20. Takahashi K, Muraoka K, Sugiura T, Maeda Y, Mandai S, Gohda Y, et al. [Middle meningeal artery embolization for refractory chronic subdural hematoma: 3 case reports]. No Shinkei Geka. 2002; 30:535–539. PMID: 11993178.

21. Tanaka T, Fujimoto S, Saito K, Kaimori M. [Histological study of operated cases of chronic subdural hematoma in adults: relationship between dura mater and outer membrane]. No Shinkei Geka. 1997; 25:701–705. PMID: 9266562.

22. Tanaka T, Fujimoto S, Saitoh K, Satoh S, Nagamatsu K, Midorikawa H. [Superselective angiographic findings of ipsilateral middle meningeal artery of chronic subdural hematoma in adults]. No Shinkei Geka. 1998; 26:339–347. PMID: 9592815.

23. Tempaku A, Yamauchi S, Ikeda H, Tsubota N, Furukawa H, Maeda D, et al. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature. Interv Neuroradiol. 2015; 21:366–371. PMID: 26015518.

24. Vega-Sosa A, de Obieta-Cruz E, Hernández-Rojas MA. Intracranial arachnoid cyst. Cir Cir. 2010; 78:551–556. PMID: 21214995.