TY - JOUR
T1 - Middle Meningeal Artery Embolization for the Treatment of an Expanding Epidural Hematoma
AU - Zussman, Benjamin M.
AU - Goldschmidt, Ezequiel
AU - Faraji, Amir H.
AU - Salvetti, David J.
AU - Jankowitz, Brian T.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/8
Y1 - 2019/8
N2 - Introduction: Epidural hematomas (EHs) usually originate from traumatic injury to the middle meningeal artery (MMA). Although large EHs may need to be emergently evacuated, the management of smaller EHs is less clear, especially in the absence of significant mass effect or neurologic deficits. Endovascular treatment via MMA embolization for epidural hematomas has only been recently reported. Herein, we present a case whereby MMA embolization was performed to prevent further growth of an expanding, right-sided EH after a larger left EH was surgically evacuated. Case Description: A 31-year-old male patient was brought to the emergency department after he was found down by the police at his house. He was initially conversant but quickly became obtunded within a few minutes. An initial scan showed bilateral (left larger than right) acute EHs, and the patient was taken to the operating room for a left craniotomy. Immediate postoperative imaging demonstrated an expanding right-sided EH. The patient was emergently taken to the endovascular suite and obvious contrast extravasation was noticed from the parietal branch of the MMA. The MMA was embolized via a transradial approach. Follow-up imaging revealed stable hematoma size without the need for additional surgery. The patient was discharged without any neurologic deficits. Conclusions: Herein, we report the successful endovascular treatment of an expanding EH following a contralateral craniotomy. Active bleeding of the MMA was observed via angiography and may predict further EH expansion. Endovascular exploration and possible treatment can be justified in patients with EH that do not have a clear surgical indication.
AB - Introduction: Epidural hematomas (EHs) usually originate from traumatic injury to the middle meningeal artery (MMA). Although large EHs may need to be emergently evacuated, the management of smaller EHs is less clear, especially in the absence of significant mass effect or neurologic deficits. Endovascular treatment via MMA embolization for epidural hematomas has only been recently reported. Herein, we present a case whereby MMA embolization was performed to prevent further growth of an expanding, right-sided EH after a larger left EH was surgically evacuated. Case Description: A 31-year-old male patient was brought to the emergency department after he was found down by the police at his house. He was initially conversant but quickly became obtunded within a few minutes. An initial scan showed bilateral (left larger than right) acute EHs, and the patient was taken to the operating room for a left craniotomy. Immediate postoperative imaging demonstrated an expanding right-sided EH. The patient was emergently taken to the endovascular suite and obvious contrast extravasation was noticed from the parietal branch of the MMA. The MMA was embolized via a transradial approach. Follow-up imaging revealed stable hematoma size without the need for additional surgery. The patient was discharged without any neurologic deficits. Conclusions: Herein, we report the successful endovascular treatment of an expanding EH following a contralateral craniotomy. Active bleeding of the MMA was observed via angiography and may predict further EH expansion. Endovascular exploration and possible treatment can be justified in patients with EH that do not have a clear surgical indication.
KW - Endovascular treatment
KW - Epidural hematoma
KW - Middle meningeal artery
KW - Middle meningeal artery embolization
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U2 - 10.1016/j.wneu.2019.05.084
DO - 10.1016/j.wneu.2019.05.084
M3 - Article
C2 - 31108255
AN - SCOPUS:85066764931
VL - 128
SP - 284
EP - 286
JO - World neurosurgery
JF - World neurosurgery
SN - 1878-8750
ER -