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Recurrent Bilateral Chronic Subdural Hematoma After Interventional Embolization Combined With Drilling and Drainage
Henglu Wang1, Chao Wang, Zefu Li
1Department of Neurosurgery, Binzhou Medical University Affiliated Hospital, Binzhou, China.
Insights
Surgical drainage is standard for chronic subdural hematoma (CSDH). Middle meningeal artery embolization combined with surgery may reduce CSDH recurrence, offering a new treatment strategy for unilateral and bilateral CSDH.
Area of Science:
- Neurosurgery
- Interventional Radiology
Background:
- Chronic subdural hematoma (CSDH) is typically treated with surgical drilling and drainage.
- Bilateral CSDHs (bCSDHs) are often managed with unilateral evacuation, despite a high recurrence rate.
Observation:
- The recurrence mechanism of bCSDH may differ from unilateral CSDH (uCSDH).
- Middle meningeal artery embolization (MMAE) is proposed to block CSDH blood supply and reduce recurrence.
Findings:
- Combining MMAE with drilling and drainage could be an effective strategy for uCSDH.
- Further research is needed to find more effective treatments for bCSDH, considering potential differences in recurrence mechanisms.
Implications:
- This approach may offer a more effective treatment for CSDH, potentially reducing recurrence rates.
- Investigating MMAE for bCSDH could lead to improved patient outcomes.
Abstract:
The main treatment for chronic subdural hematoma (CSDH) is surgical drilling and drainage. Meanwhile, the most accepted treatment strategy for bilateral CSDHs (bCSDHs) is unilateral evacuation only on the larger or symptomatic side because the contralateral hematoma is generally either small or asymptomatic. However, the probability of recurrence is high. To effectively reduce this recurrence rate, embolization has been proposed. Because middle meningeal artery embolization may effectively block the blood supply of the CSDH, its combination with drilling and drainage could be an effective treatment strategy for addressing unilateral CSDH (uCSDH). In addition, the recurrence mechanism of bCSDH may be not completely same as that of the uCSDH. Hence, the authors need find a more effective treatment for it.
