Failure of MMA embolization due to deep and middle temporal artery supply in chronic subdural hematoma: the diagnostic value of 3D-RA.
case_report · Level V
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- Record sourced from PubMed, PMID 41991629.
- Also identified by DOI 10.1007/s00701-026-06882-8.
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Abstract
Chronic subdural hematoma (CSDH) is commonly managed with burr hole evacuation, yet recurrence remains frequent. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive treatment. We describe the case of an 85-year-old man with refractory CSDH who developed multiple recurrences despite repeated surgical evacuation and MMA embolization. Three-dimensional rotational angiography (3D-RA) revealed atypical transosseous feeders from the anterior and middle deep temporal arteries and the middle temporal artery. Targeted embolization using N-butyl cyanoacrylate and coils resulted in durable hematoma resolution without further recurrence. This case highlights the importance of detailed vascular assessment with 3D-RA when MMA embolization fails.