A case of recurrent subdural hematoma after unilateral MMA embolization that resolved after contralateral MMA embolization.
Yigit Can Senol, Mona Asghariahmadabad, Daniel L Cooke et al.
✦ AI-curated · Sources linked
Case in brief
An elderly patient with a large acute-on-chronic subdural hematoma underwent surgical drainage and ipsilateral middle meningeal artery embolization using 150–250 µm Contour PVA particles. At one-month follow-up, imaging showed significant hematoma recurrence with interval acute hemorrhage. Angiography demonstrated occlusion of the treated artery’s trunk but robust contralateral middle meningeal artery branches crossing the midline and supplying its patent distal branches. After embolization of the contralateral artery, the hematoma showed near-complete resolution at six months.
What made this case unusual
Despite occlusion of the ipsilateral middle meningeal artery trunk, contralateral branches crossed the midline and collateralized its distal branches; recurrence resolved after embolization of the contralateral artery.
Diagnostic / clinical pearl
In recurrent subdural hematoma after ipsilateral middle meningeal artery embolization, angiography may reveal contralateral cross-midline collateral supply to the treated side’s distal branches.