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Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 421-424

Organized chronic subdural hematoma treated with middle meningeal artery embolization and small craniotomy: Two case reports

1 Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
2 Department of Neurology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan
3 Department of Radiology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Ritto, Shiga, Japan

Correspondence Address:
Dr. Shigeomi Yokoya
2-4-1 Ohashi, Ritto-City, Shiga 520-3046
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajns.AJNS_341_19

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The most preferred treatment for organized chronic subdural hematoma (OSDH) remains controversial. Although a large craniotomy has been reported to be necessary and effective for the treatment of an OSDH, a craniotomy is associated with postoperative hemorrhagic complications and recurrence. Although middle meningeal artery (MMA) embolization has been reported to be effective for a refractory chronic subdural hematoma (CSDH), its efficacy for an OSDH remains unclear. We report two cases of OSDH treated with MMA embolization followed by hematoma removal via a small craniotomy under local anesthesia with good progress. Case 1: A 71-year-old man underwent a single burr hole irrigation for a CSDH, which failed due to a solid hematoma. He underwent a small craniotomy under local anesthesia after an MMA embolization. During the craniotomy, a small hemorrhage from the hematoma and its outer membrane was observed. Postoperatively, the symptoms disappeared immediately, and the hematoma did not recur. Case 2: A 77-year-old man underwent a burr hole irrigation, but the hematoma was not evacuated because of an OSDH, and he remained in motor aphasia. After an MMA embolization, a craniotomy was performed under local anesthesia. Intraoperative hemorrhage was minimal, and after the craniotomy, his neurological symptoms improved without any recurrence. MMA embolization and hematoma removal with a small craniotomy could be a treatment option for an OSDH.

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