Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access
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Case Report

Volume 13, Number 1-2, April 2024, pages 39-45

Middle Meningeal Artery Embolization in Acute Leukemia Patients Presenting With Subdural Hematoma

Figures

Figure 1.
Figure 1. (a) Preoperative CT head showing left cerebral convexity subdural hematoma (arrows), measuring up to 1.1 cm in thickness. There is an associated rightward midline shift of 6 mm at the level of the foramen of Monro and trace subarachnoid hemorrhage in the left frontal lobe. (b) MRI brain done 7 months later showing resolved subarachnoid hemorrhage along the left cerebral convexity and right parafalcine region with no evidence of residual or recurrence hemorrhage. CT: computed tomography; MRI: magnetic resonance imaging.
Figure 2.
Figure 2. Cerebral angiogram showing the left middle meningeal artery (MMA) region (a). Post-embolization images (b) show a completely occluded left MMA (arrows).
Figure 3.
Figure 3. Subdural collections overlying the right and left parieto-occipital convexities and measuring up to 2.0 cm on the left and 1.3 cm on the right, with a mass effect of 3 mm mild left-to-right midline shift (a). (b) Interval improvement of the mass effect on the left with persistent 1 mm midline shift toward the right.

Table

Table 1. Previous Reports of Middle Meningeal Artery (MMA) Embolization in cSDH Patients
 
AuthorStudy typeNumberRecurrence rate/treatment failure rateNeed for salvage surgery/further SDH therapy% with stability/improvement or reduction in size of SDH
cSDH: chronic subdural hematoma; SDH: subdural hematoma; NA: not available.
Ban et al, 2018 [20]Case control721.4% vs. 27.5% (MMA embolization vs. conventional therapies)1.4% vs. 18.8% (MMA embolization vs. conventional therapies)
Link et al, 2019 [18]Single-center retrospective608.9%8.9%68.9%
Joyce et al, 2020 [19]Multicenter retrospective1514.6% for elderly (age 65 - 79 years); 7.8% for advanced elderly (age > 80 years)91% in elderly; 98% in advanced elderly
Kan et al, 2021 [17]Multicenter retrospective1546.5%70.8%
Srivatsan et al, 2019 [21]Systematic review and meta-analysisMMA embolization (2.1%) vs. conventional therapy (27.7%)NANA
Ironside et al, 2021 [22]Systematic review and meta-analysis1416MMA embolization (4.8%) vs. conventional therapy (21%)NANA