Skip to main content

Advertisement

SpringerLink
Log in

Middle meningeal artery embolization for pediatric chronic subdural hematoma under anticoagulant therapy with ventricular assist device: a case report

  • Case Report
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Introduction

Recently, the efficacy of middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH) in the elderly has been reported. However, no previous reports of MMA embolization for cSDH in children with ventricular assist devices (VAD) have been published. Here, we report a case of MMA embolization for cSDH in a child with VAD.

Case

A 15-month-old female was diagnosed with dilated cardiomyopathy at 7 months old. Soon, a VAD was inserted, and anticoagulant and antiplatelet therapy was started. Bilateral cSDH was observed at 15 months, and, 2 months later, an acute exacerbation of the right cSDH necessitated intracerebral hemorrhage removal. Afterwards, increased intracranial pressure occurred due to a contralateral subdural hematoma but, 4 months after intracerebral hemorrhage removal, CT showed new hemorrhaging in the left cSDH. MMA embolization was then conducted to prevent rebleeding in the hematoma. Selective angiography of the left MMA demonstrated stains of hematoma capsules from the frontal and parietal branches, which were embolized using liquid embolic material. During the procedure, the material migrated into the intracranial vessels via an undetected transdural anastomosis. Postoperatively, no new neurological abnormalities, including hemiparesis, were observed. Two months later, CT showed a decrease in hematoma size.

Conclusion

MMA embolization for cSDH in pediatric patients with VAD may be effective, if vigilance is maintained against transdural anastomoses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ducruet AF, Grobelny BT, Zacharia BE, Hickman ZL, DeRosa PL, Andersen KN, Sussman E, Carpenter A, Connolly ES Jr (2012) The surgical management of chronic subdural hematoma. Neurosurg Rev 35:155–169

    Article  Google Scholar 

  2. Atsumi H, Sorimachi T, Honda Y, Sunaga A, Matsumae M (2019) Effects of pre-existing comorbidities on outcomes in patients with chronic subdural hematoma. World Neurosurg 122:e924–e932

    Article  Google Scholar 

  3. Fornebo I, Sjavik K, Alibeck M, Kristiansson H, Stahl F, Forander P, Jakola AS, Bartek J Jr (2017) Role of antithrombotic therapy in the risk of hematoma recurrence and thromboembolism after chonic subdural hematoma evacuation: a population-based consecutive cohort study. Acta Neurochir (Wien) 159:2045–2052

    Article  Google Scholar 

  4. Wang Y, Zhou J, Fan C, Wang D, Jiao F, Liu B, Zhang Q (2017) Influence of antithrombotic agents on the recurrence of chronic subdural hematomas and the quest about the recommencement of antithrombotic agents: a meta-analysis. J Clin Neurosci 38:79–83

    Article  Google Scholar 

  5. Mayer PR, Hwang SW, Reddy GD, Morales DL, Whitehead WE, Curry DJ, Bollo RJ, Luerssen TG, Jes A (2012) Neurosurgical complications of left ventricular assist devices in children. J Neurosurg Pediatr 10:370–375

    Article  Google Scholar 

  6. Carroll AH, Ramirez MP, Dowlati E, Mueller KB, Borazjani A, Chang JJ, Felbaum DR (2021) Management of intracranial hemorrhage in patients with a left ventricular assist device: a systematic review and meta-analysis. J Stroke Cerebrovascu Dis 30:105501

  7. Ban SP, Hwang G, Byoun HS, Kim T, Lee SU, Bang JS, Han JH, Kim CY, Kwon OK, Oh CW (2018) Middle meningeal artery embolization for chronic subdural hematoma. Radiology 286:992–999

    Article  Google Scholar 

  8. Waqas M, Vakhari K, Weimer PV, Hashmi E, Davies JM, Siddiqui AH (2019) Safety and effectiveness of embolization for chronic subdural hematoma: systematic review and case series. World Neurosurg 126:228–236

    Article  Google Scholar 

  9. Catapano JS, Ducruet AF, Nguyen CL, Baranoski JF, Cole TS, Majmundar N, Wilkinson DA, Fredrickson VL, Cavalcanti DD, Albuquerque FC (2020) Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis. J Neurointerv Surg. 19:ahead of print

  10. Kan P, Maragkos GA, Srivatsan A et al (2021) Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations. Neurosurgery 88:268–277

    Article  Google Scholar 

  11. Lampropulos JF, Kim N, Wang Y, Desai MM, Barreto-Filho JA, Dodson JA, Dries DL, Mangi AA, Krumholz HM (2014) Trends in left ventricular assist device use and outcomes among Medicare beneficiaries, 2004–2011. Open Heart 1:e000109

  12. Lai GY, Devlin PJ, Kesavabhotla K, Rich JD, Pham DT, Potts MB, Jahromi BS (2019) Management and outcome of intracranial hemorrhage in patients with left ventricular assist devices. J Neurosurg 132:1133–1139

    Article  Google Scholar 

  13. Niebler RA, Lew SM, Zangwill SD, Woods RK, Mitchell ME, Tweddell JS, Ghanayem NS (2014) Incidence and outcome of pediatric patients with intracranial hemorrhage while supported on ventricular assist devices. Artif Organs 38:73–78

    Article  Google Scholar 

  14. Tahir RA, Rotman LE, Davis MC, Dupepe EB, Kole MK, Rahman M, Williams CT, Pamboukian SV, Bazydlo M, Walters BC (2018) Intracranial hemorrhage in patients with a left ventricular assist device. World Neurosurg 113:e714–e721

    Article  Google Scholar 

  15. Haldrup M, Ketharanathan B, Debrabant B, Schwartz OS, Mikkelsen R, Fugleholm K, Poulsen FR, Jensen TSR, Thaarup LV, Bergholt B (2020) Embolization of the middle meningeal artery in patients with chronic subdural hematoma-a systematic review and meta-analysis. Acta Neurochir (Wien) 162:777–784

    Article  Google Scholar 

  16. Srivatsan A, Mohanty A, Nascimento FA, Hafeez MU, Srinivasan VM, Thomas A, Chen SR, Johnson JN, Kan P (2019) Middle meningeal artery embolization for chronic subdural hematoma: meta-analysis and systematic review. World Neurosurg 122:613–619

    Article  Google Scholar 

  17. Storey A, Michael Scott R, Robertson R, Smith E (2017) Preoperative transdural collateral vessels in moyamoya as radiographic biomarkers of disease. J Neurosurg Padiatr 19:289–295

    Article  Google Scholar 

  18. Shapiro M, Walker M, Carroll KT, Levitt MR, Raz E, Nossek E, Delavari N, Mir O, Nelson PK (2021) Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization. J NeuroIntervent Surg 25:ahead of print

  19. Choi BR, Kim JS, Yang YJ et al (2006) Factors associated with decreased cerebral blood flow in congestive heart failure secondary to idiopathic dilated cardiomyopathy. Am J Cardiol 97:1365–1369

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr. Alexander Zaboronok of the University of Tsukuba Faculty of Medicine Department of Neurosurgery for professional and language revision and Dr. Bryan J. Mathis of the University of Tsukuba Hospital International Medical Center for language revision.

Author information

Authors and Affiliations

  1. Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Osamu Yazawa, Yoshiro Ito, Taisuke Akimoto, Masayuki Sato & Yuji Matsumaru

  2. Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan

    Osamu Yazawa, Yoshiro Ito, Taisuke Akimoto, Masayuki Sato, Yuji Matsumaru & Eiichi Ishikawa

Authors
  1. Osamu Yazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshiro Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taisuke Akimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masayuki Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuji Matsumaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eiichi Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshiro Ito.

Ethics declarations

Consent for publication

The patient provided informed, written consent to participate in this research.

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yazawa, O., Ito, Y., Akimoto, T. et al. Middle meningeal artery embolization for pediatric chronic subdural hematoma under anticoagulant therapy with ventricular assist device: a case report. Childs Nerv Syst 38, 1397–1400 (2022). https://doi.org/10.1007/s00381-021-05418-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-021-05418-y

Keywords

Search

Navigation