Middle meningeal artery embolization for treatment of bilateral mixed-attenuation subdural hematomas in an infant: illustrative case.

Background: Chronic subdural hematoma (cSDH) is a collection of blood that accumulates between the dura and arachnoid meningeal layers, commonly associated with traumatic tearing of the cortical bridging veins and a chronic inflammatory response. Chronic SDH predominantly affects elderly populations, with rare occurrences in children. Middle meningeal artery (MMA) embolization is a minimally invasive procedure proven in adult neurological care of cSDH. However, the efficacy of this treatment in the management of cSDH in the pediatric population is yet to be proven.

Observations: A 5-month-old female patient with a history of von Willebrand disease presented at the age of 2 months with irritability, seizures, and bilateral ecchymosis. Subsequent imaging revealed bilateral SDHs over the cerebral and cerebellar hemispheres. She underwent bilateral burr hole drainage and subdural to peritoneal shunts that ultimately required several revisions, including a valve replacement due to shunt malfunctions. Given conventional treatment failure, she was then treated with bilateral MMA embolization, resulting in resolution of her acute, subacute, and chronic SDH. At the 15-month follow-up, she met all developmental milestones, was neurologically intact, seizure free, and MRI did not reveal a cSDH.

Lessons: MMA embolization is effective in the treatment of bilateral mixed-attenuation SDHs after failure of conventional treatments in pediatric populations. https://thejns.org/doi/10.3171/CASE2579.