Diplopia after middle meningeal artery embolization for chronic subdural hematoma: A case report.

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

World Journal of Clinical Cases Pub Date : 2025-08-16 DOI:10.12998/wjcc.v13.i23.106329

Feng Zhao, Chun-Hai Su, Shun-Xin Hu, Lei Feng

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Abstract

Background: Middle meningeal artery embolization (MMAE) is emerging as a promising treatment for chronic subdural hematoma (CSDH), serving both as an adjunct to surgery and as a primary therapeutic option depending on patient presentation. Due to its low recurrence rate and minimal complications, MMAE has gained increasing acceptance among clinicians in recent years. This report presents a case of diplopia following MMAE due to the presence of a potential anastomotic artery, aiming to enhance awareness of this complication.

Case summary: A 60-year-old male patient presented with a headache following head trauma, and cranial computed tomography revealed a left-sided CSDH. The patient underwent left MMAE; however, polyvinyl alcohol particles inadvertently flowed into the lacrimal artery through an anastomotic artery, resulting in diplopia due to impaired abduction of the left eye. The diplopia resolved by postoperative day 40. The patient's headache resolved by postoperative day 7, and the hematoma completely resolved by postoperative day 108.

Conclusion: Potential anastomotic arteries in the middle meningeal artery (MMA) can lead to serious complications. Superselective angiography of the MMA or its branches prior to embolization is essential. Performing embolization distal to potential anastomotic sites can reduce risks, and the presence of an anastomosis may warrant coil embolization or termination of the procedure.

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脑膜中动脉栓塞治疗慢性硬膜下血肿后复视1例。

背景：脑膜中动脉栓塞（MMAE）作为慢性硬膜下血肿（CSDH）的一种有前景的治疗方法，既可以作为手术的辅助手段，也可以根据患者的表现作为主要的治疗选择。由于其低复发率和最小的并发症，MMAE近年来越来越被临床医生所接受。本报告报告一例MMAE术后复视，由于存在潜在的吻合动脉，旨在提高对这种并发症的认识。病例总结：一名60岁男性患者，头部外伤后出现头痛，颅脑ct显示左侧CSDH。患者行左侧MMAE；然而聚乙烯醇颗粒不经意间通过吻合动脉流入泪动脉，导致左眼外展受损导致复视。术后第40天复视消退。术后第7天头痛消失，术后第108天血肿完全消失。结论：潜在的吻合动脉位于脑膜中动脉（MMA）可导致严重的并发症。栓塞前对MMA或其分支进行超选择性血管造影是必要的。在潜在的吻合点远端进行栓塞可以降低风险，并且存在吻合点可能需要线圈栓塞或终止手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Clinical Cases Medicine-General Medicine

自引率

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3384

期刊介绍： The World Journal of Clinical Cases (WJCC) is a high-quality, peer reviewed, open-access journal. The primary task of WJCC is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of clinical cases. In order to promote productive academic communication, the peer review process for the WJCC is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJCC are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in clinical cases.