• Yu Okuma, Nobuyuki Hirotsune, Yu Sato, Tomoyuki Tanabe, Kenichiro Muraoka, and Shigeki Nishino.
• Department of Neurological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. Electronic address: y8u2bear4@hotmail.com.
• World Neurosurg. 2019 Jun 1; 126: e671-e678.

ObjectiveA subset of patients with chronic subdural hematoma (CSDH) remains refractory to standard treatment with hematoma drainage by burr-hole craniotomy and irrigation. We recently reported the usefulness of middle meningeal artery (MMA) embolization for intractable CSDH in patients with multiple intractable risk factors. We present the midterm outcomes of MMA embolization in patients with intractable CSDHs.Methods And ResultsSeventeen consecutive patients (average age, 76.4 years; 12 men [71%]) underwent MMA embolization of CSDH from January 2014 to July 2017. Earlier interventions included embolization using N-butyl-2-cyanoacrylate (although trisacryl gelatin microspheres were used in recent cases), followed by burr-hole craniotomy and irrigation in all cases. None of the patients experienced perioperative complications or postoperative recurrence. The modified Rankin Scale scores, which were unfavorable at admission, improved significantly at discharge but were comparable to those at the time of hospitalization when measured during the follow-up period. Although the patients required rehospitalization at other departments for unrelated causes, none required rehospitalization in our department.ConclusionsDespite the known unfavorable outcomes of patients with intractable CSDHs, MMA embolization was not associated with recurrent CSDH or rehospitalization in our department in the current case series. MMA embolization should be considered a preferred therapeutic option for intractable CSDHs.Copyright © 2019 Elsevier Inc. All rights reserved.

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