• Tushit Mewada, Tomotaka Ohshima, Taiki Yamamoto, Shunsaku Goto, and Yoko Kato.
• Department of Neurosurgery, G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India; Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan.
• World Neurosurg. 2016 Aug 1; 92: 584.e7-584.e10.

BackgroundRefractory chronic subdural hematomas due to iatrogenic dural arteriovenous fistulas (dAVFs) are difficult to treat. We report our experience and propose a guideline on basis of a literature review for the usefulness of embolization of middle meningeal artery (MMA) for the treatment of the same.Case DescriptionWe report a case with right hemiparesis and aphasia 1 month after a fall from a bicycle. Computed tomography scan of the head showed left chronic subdural hematoma, which was evacuated by burr-hole drainage. The postoperative course was complicated by reaccumulation within short period of time. On superselective digital subtraction angiography of MMA, iatrogenic dAVF was found on left side. We embolized successfully it using n-butyl cyanoacrylate after a third irrigation. No reaccumulation found in the postoperative period or at last follow-up. We propose treatment protocol based on our experience and literature review.ConclusionRefractory chronic subdural hematoma with reaccumulation within a short interval should be subjected to digital subtraction angiography of the MMA. Embolization of ipsilateral MMA is safe, effective, and a useful option for the treatment of iatrogenic dAVF and resolution of hematoma.Copyright © 2016 Elsevier Inc. All rights reserved.

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