• World Neurosurg · Jan 2020

    Case Reports

    Refractory chronic subdural hematoma associated with dural metastasis of lung adenocarcinoma treated with endovascular embolization for the middle meningeal artery: a case report.

    • Takuya Kosaka, Naokado Ikeda, Motomasa Furuse, Naosuke Nonoguchi, Ryo Hiramatsu, Ryokichi Yagi, Shinji Kawabata, Shigeru Miyachi, Toshihiko Kuroiwa, and Masahiko Wanibuchi.
    • Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
    • World Neurosurg. 2020 Jan 1; 133: 256-259.

    BackgroundEndovascular embolization of the middle meningeal artery (MMA) is effective for recurrent chronic subdural hematoma (CSDH). CSDH associated with dural metastasis is generally refractory to burr hole surgery and has poor prognosis even if any interventions are applied. To the best of our knowledge, this study is the first to report a case of refractory CSDH associated with dural metastasis that was successfully treated with embolization of the MMA.Case DescriptionA 66-year-old man with a 1-year history of lung adenocarcinoma had also undergone whole-brain irradiation for multiple brain metastases 5 months before presentation, surgical removal of relapse of brain metastases 3 months prior, and stereotactic radiotherapy for the relapses 1 month prior. He was admitted to our institution with speech disturbance, severe headache, and right-sided motor weakness. Head computed tomography on admission revealed left-sided CSDH, and emergency burr hole irrigation surgery was performed. However, CSDH recurred twice in a short period after hospitalization. Histological examination revealed adenocarcinoma cells in the dura mater and in hematoma samples during the first surgery; therefore, the patient was diagnosed with refractory CSDH associated with dural metastasis of lung adenocarcinoma. We performed endovascular embolization of the MMA, followed by systemic chemotherapy at 1 month after embolization, and no recurrence of the CSDH was observed.ConclusionsEmbolization of the MMA has few surgical risks and could be a treatment option for refractory CSDH associated with dural metastasis because it might prolong the therapeutic time window until radical therapies are administered.Copyright © 2019 Elsevier Inc. All rights reserved.

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