The Utility of Preoperative CT Angiography for Middle Meningeal Artery Embolization in Acute Epidural Hematoma.

Abstract

Objective: Hematoma expansion in acute epidural hematomas occurred in 11.2%-32% of patients treated conservatively at initial presentation and required craniotomy. Middle meningeal artery (MMA) embolization has been reported to be effective in preventing hematoma expansion. We report a case of an asymptomatic acute epidural hematoma in which CTA was used to identify the source of bleeding. Embolization of the MMA was performed to prevent hematoma expansion.

Case presentation: A 30-year-old male patient was admitted to the emergency department following a collision with a car while riding his motorcycle. The patient exhibited clear consciousness and no neurological deficits. A head CT scan revealed a right parietal and temporal bone fracture, and an acute epidural hematoma directly below the fracture site. The hematoma was small, and the patient was treated conservatively. Three hours later, a follow-up head CT scan revealed an enlarged hematoma. This hematoma was found near the transverse sinus. To identify the source of the bleeding, a CTA was performed, which revealed extravasation into the hematoma from an area distant from the transverse sinus. We performed embolization of the MMA. The postoperative course was good with no postoperative hematoma expansion.

Conclusion: CTA for acute epidural hematoma without neurological symptoms is a useful diagnostic tool that can identify patients at high risk for hematoma expansion. If the findings indicate the need for intervention, MMA embolization is a treatment option that may reduce the risk of hematoma expansion and craniotomy.