Introduction Large subdural hematomas with brain compression and severe neurological deficits are treated with surgical drainage of blood. Management of asymptomatic individuals and patients with minimal deficits pose strategical challenge to the treating physician. After the evolution of middle meningeal artery embolization as one the treatment strategy of cSDH, many patients are getting benefited by preventing recurrence and sometimes avoiding invasive surgery.
Case Description A 70 year old male presented with 1 month history of mild headache, mental slowing, forgetfulness and unsteadiness of gait. He was evaluated with a plain computed tomography of brain which showed right Subacute subdural hematoma. Patient was taken for endovascular treatment. Diagnostic runs of angiogram showed relatively enlarged right Middle Meningeal Artery and cotton wool like appearance that signifies leak and Neovascularisation of blood that causes non-acute SDH. Following the procedure, there was a quick relief from the headache that he had and was totally symptom free by end of one month. CT scans taken at 1 month and 3 months showed serial reduction in hematoma size and decrease in mass effect on the brain.
Discussion Evacuation through invasive surgery caries around 10% recurrence whereas SDH recurrence after MMA embolization ranges from 2–7% from various case series. The absence of severe symptoms or a disabling spinomotor deficit make the patient a likely candidate for less invasive standalone management.
Conclusion Middle meningeal artery embolization done as standalone will be a novel treatment approach for chronic Subdural hematoma when selected appropriately.
Disclosure of Interest Nothing to disclose
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