Recurrent Acute Subdural Hematoma Due to Middle Meningeal Artery Bleeding Treated by Embolization

Recurrent acute subdural hematomas (ASDHs) are a common complication of neurosurgical operations. However, ASDHs associated with middle meningeal artery (MMA) injury are extremely rare. We encountered a rare case of recurrent ASDH due to MMA bleeding after craniotomy for a nontraumatic ASDH and successfully performed MMA embolization for treatment of it.

A 56-year-old woman was admitted to our department with progressively worsening headache and vomiting approximately 1 week. She had no history of head trauma and illness. A head computed tomography (CT) scan revealed an ASDH on the right hemisphere. The patient underwent a right-sided craniotomy for evacuation of the hematoma. Two days later, she exhibited impaired consciousness and a repeat CT scan showed a recurrent ASDH. To clarify the cause, we performed cerebral digital subtraction angiography for the patient. Obvious contrast extravasation from the anterior branch of the right MMA was noticed. It was considered to be related to the recurrent ASDH. Embolization of the MMA was performed using Onyx 18 (Micro Therapeutics, Inc., Irvine, California, USA). Follow-up CT scans showed progressive resolution of the ASDH and no recurrence. The patient was discharged without any neurologic deficits.

In our case, the relationship between the recurrent ASDH and MMA was observed via angiography and MMA embolization was successfully performed to avoid surgery for reevacuation, suggesting that active bleeding of MMA may be a cause of recurrent ASDH after neurosurgical operations and endovascular exploration, and possible treatment is necessary for an unexplained ASDH.