TY - JOUR
T1 - Middle Meningeal Artery Embolization of a Pediatric Patient with Progressive Chronic Subdural Hematoma
AU - Shigematsu, Tomoyoshi
AU - Dier, Evelyn
AU - Yaeger, Kurt A.
AU - Morgenstern, Peter F.
AU - Glass, Lauren D.
AU - Kellner, Christopher P.
AU - Berenstein, Alejandro
N1 - Publisher Copyright:
© 2021 Congress of Neurological Surgeons 2021.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - BACKGROUND AND IMPORTANCE: Evidence suggests middle meningeal artery (MMA) embolization benefits adult patients with chronic subdural hematoma (CSDH) at high risk for recurrence or hemorrhagic complications. Yet, there has not been any report discussing MMA embolization in the pediatric population. Thus, we present a case of an infant with CSDH successfully managed with MMA embolization without surgical management. CLINICAL PRESENTATION: A 5-mo-old girl with idiopathic dilated cardiomyopathy underwent surgical implantation of a left ventricular assist device for a bridge to heart transplantation. This was complicated by left ventricular thrombus causing stroke. She was placed on dual antiplatelet antithrombotic therapy on top of bivalirudin infusion. She sustained a left middle cerebral artery infarction, but did not have neurological deficits. Subsequent computed tomography scans of the head showed a progressively enlarging asymptomatic CSDH, and the heart transplant was repeatedly postponed. The decision was made to proceed with MMA embolization at the age of 7 mo. Bilateral modified MMA embolization, using warmed, low-concentration n-butyl-cyanoacrylate (n-BCA) from distal microcatheter positioning, allowed the embolic material to close the distal MMA and subdural membranous vasculature. The patient underwent successful heart transplant and the CSDH improved significantly. She remained neurologically asymptomatic and had normal neurological development after the MMA embolization. CONCLUSION: MMA embolization may represent a safe and effective minimally invasive option for pediatric CSDH, especially for patients at high risk for surgery or hematoma recurrence.
AB - BACKGROUND AND IMPORTANCE: Evidence suggests middle meningeal artery (MMA) embolization benefits adult patients with chronic subdural hematoma (CSDH) at high risk for recurrence or hemorrhagic complications. Yet, there has not been any report discussing MMA embolization in the pediatric population. Thus, we present a case of an infant with CSDH successfully managed with MMA embolization without surgical management. CLINICAL PRESENTATION: A 5-mo-old girl with idiopathic dilated cardiomyopathy underwent surgical implantation of a left ventricular assist device for a bridge to heart transplantation. This was complicated by left ventricular thrombus causing stroke. She was placed on dual antiplatelet antithrombotic therapy on top of bivalirudin infusion. She sustained a left middle cerebral artery infarction, but did not have neurological deficits. Subsequent computed tomography scans of the head showed a progressively enlarging asymptomatic CSDH, and the heart transplant was repeatedly postponed. The decision was made to proceed with MMA embolization at the age of 7 mo. Bilateral modified MMA embolization, using warmed, low-concentration n-butyl-cyanoacrylate (n-BCA) from distal microcatheter positioning, allowed the embolic material to close the distal MMA and subdural membranous vasculature. The patient underwent successful heart transplant and the CSDH improved significantly. She remained neurologically asymptomatic and had normal neurological development after the MMA embolization. CONCLUSION: MMA embolization may represent a safe and effective minimally invasive option for pediatric CSDH, especially for patients at high risk for surgery or hematoma recurrence.
KW - Anticoagulation
KW - Antiplatelets
KW - Chronic subdural hematoma
KW - Congenital heart disease
KW - Middle meningeal artery embolization
KW - Pediatric chronic subdural hematoma
KW - Ventricular assist device
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U2 - 10.1093/ons/opab144
DO - 10.1093/ons/opab144
M3 - Article
C2 - 33957675
AN - SCOPUS:85114287599
SN - 2332-4252
VL - 21
SP - E274-E277
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 3
ER -