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

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.