Transradial embolization of the left middle meningeal artery and accessory middle meningeal artery for treatment of subacute–chronic subdural hematoma
Gary Rajah, Michael K. Tso, Rimal H. Dossani, Kunal Vakharia, Adnan H. Siddiqui
Abstract
This 52-year-old man with no remarkable medical history, no anticoagulation use, and no history of trauma was noted to have a subacute–chronic left subdural hematoma during outpatient headache evaluation. No occult vascular lesion or cross-calvarial supply of the right middle meningeal artery (MMA) to the left side was identified on bilateral selective external carotid injections. Because the patient preferred non-surgical management, we performed a left MMA embolization with Onyx 18 (Medtronic), utilizing a Headway Duo microcatheter (MicroVention) via the transradial route. A 6 French Benchmark (Penumbra) was utilized for transradial support into the left external carotid. The patient was discharged home the same day. Repeat scans from 2 to 6 weeks revealed complete resolution of the subdural hematoma. The patient’s headaches resolved. Transradial MMA embolization for subacute–chronic subdural hematoma represents a minimally invasive treatment option for mass effect and hemorrhage-related symptoms. Tailored embolizations are necessary when >1 meningeal vessel supplies the subdural hematoma.