{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:13:48Z","timestamp":1769732028873,"version":"3.49.0"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"19","license":[{"start":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T00:00:00Z","timestamp":1730678400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,11,4]]},"abstract":"\n BACKGROUND<\/jats:title>\n Subdural hematoma is a rare manifestation of hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease. Here, the authors present a patient with HHT and a large chronic subdural hematoma, for whom nonsurgical management was pursued.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 49-year-old right-handed male with a history of hypertension and familial HHT presented with complaints of mild confusion and left hemiparesis over several days. Noncontrast head computed tomography images demonstrated a large chronic right hemisphere subdural hematoma compressing the right cerebral hemisphere and causing a 1.3-cm midline shift. Due to concerns about surgical complications arising from hemorrhages of cryptic telangiectasias, the patient was treated conservatively with middle meningeal artery embolization and adjuvant tranexamic acid. There was clinical and radiological resolution several months later.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case highlights the rarity of a subdural hematoma as a manifestation of HHT and the nonsurgical treatment strategy as a mechanism to avoid hemorrhagic complications of surgical evacuation.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24483<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24483","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T01:45:35Z","timestamp":1730684735000},"source":"Crossref","is-referenced-by-count":0,"title":["Middle meningeal artery embolization and tranexamic acid therapy for subdural hematoma in a patient with hereditary hemorrhagic telangiectasia: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Robert","family":"Kushmakov","sequence":"first","affiliation":[{"name":"Touro College of Osteopathic Medicine, New York, New York"},{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilona","family":"Cazorla-Morales","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Brenner","sequence":"additional","affiliation":[{"name":"Medicine, Hackensack Meridian School of Nutley, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Araten","sequence":"additional","affiliation":[{"name":"Medicine, NYU Grossman School of New York, New York"},{"name":"Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maksim","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eytan","family":"Raz","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitris G","family":"Placantonakis","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"12","key":"bib1","series-title":"Ann Intern Med","first-page":"989","article-title":"Second international guidelines for the diagnosis and management of hereditary hemorrhagic telangiectasia","volume":"173","author":"Faughnan","year":"2020","unstructured":"Faughnan MEMager JJHetts SW, et al. Second international guidelines for the diagnosis and management of hereditary hemorrhagic telangiectasia. Ann Intern Med. 2020;173(12):989-1001."},{"issue":"9","key":"bib2","series-title":"Haematologica","first-page":"1433","article-title":"Hereditary hemorrhagic telangiectasia: diagnosis and management from the hematologist\u2019s perspective","volume":"103","author":"Kritharis","year":"2018","unstructured":"Kritharis AAl-Samkari HKuter DJ. Hereditary hemorrhagic telangiectasia: diagnosis and management from the hematologist\u2019s perspective. Haematologica. 2018;103(9):1433-1443."},{"key":"bib3","series-title":"BMJ Case Rep","first-page":"bcr2014207852","article-title":"Rare manifestations in a case of Osler-Weber-Rendu disease","volume":"2015","author":"Singh","year":"2015","unstructured":"Singh ASuri VJain SVarma S. Rare manifestations in a case of Osler-Weber-Rendu disease. BMJ Case Rep. 2015;2015:bcr2014207852."},{"key":"bib4","series-title":"Interv Neuroradiol","first-page":"15910199241246299","article-title":"Embolization of middle meningeal artery for","author":"Shankar","year":"2024","unstructured":"Shankar JAlcock SMilot G. Embolization of middle meningeal artery for chronic subdural hematoma: do we have sufficient evidence? Interv Neuroradiol. 2024:15910199241246299."},{"key":"bib5","series-title":"Clin Neurol Neurosurg","first-page":"105464","article-title":"Embolization of the middle meningeal artery in chronic subdural hematoma\u2014a systematic review","volume":"186","author":"Court","year":"2019","unstructured":"Court JTouchette CJIorio-Morin CWestwick HJBelzile FEffendi K. Embolization of the middle meningeal artery in chronic subdural hematoma\u2014a systematic review. Clin Neurol Neurosurg. 2019;186:105464."},{"issue":"2","key":"bib6","series-title":"Neurosurgery","first-page":"268","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations","volume":"88","author":"Kan","year":"2021","unstructured":"Kan PMaragkos GASrivatsan A, et al. Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations. Neurosurgery. 2021;88(2):268-277."},{"issue":"6","key":"bib7","series-title":"Neurosurgery","first-page":"801","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases","volume":"85","author":"Link","year":"2019","unstructured":"Link TWBoddu SPaine SMKamel HKnopman J. Middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases. Neurosurgery. 2019;85(6):801-807."},{"issue":"4","key":"bib8","series-title":"Radiology","first-page":"e222045","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: predictors of clinical and radiographic failure from 636 embolizations","volume":"307","author":"Salem","year":"2023","unstructured":"Salem MMKuybu ONguyen Hoang A, et al. Middle meningeal artery embolization for chronic subdural hematoma: predictors of clinical and radiographic failure from 636 embolizations. Radiology. 2023;307(4):e222045."},{"issue":"2","key":"bib9","series-title":"J Neurosurg","first-page":"332","article-title":"Nonsurgical treatment of chronic subdural hematoma with tranexamic acid","volume":"119","author":"Kageyama","year":"2013","unstructured":"Kageyama HToyooka TTsuzuki NOka K. Nonsurgical treatment of chronic subdural hematoma with tranexamic acid. J Neurosurg. 2013;119(2):332-337."},{"key":"bib10","series-title":"World Neurosurg","first-page":"29","article-title":"Tranexamic acid for treatment of residual subdural hematoma after bedside twist-drill evacuation","volume":"91","author":"Tanweer","year":"2016","unstructured":"Tanweer OFrisoli FABravate C, et al. Tranexamic acid for treatment of residual subdural hematoma after bedside twist-drill evacuation. World Neurosurg. 2016;91:29-33."},{"issue":"3","key":"bib11","series-title":"J Neurosurg","first-page":"609","article-title":"A case-comparison study of the subdural evacuating port system in treating chronic subdural hematomas","volume":"113","author":"Rughani","year":"2010","unstructured":"Rughani AILin CDumont TMPenar PLHorgan MATranmer BI. A case-comparison study of the subdural evacuating port system in treating chronic subdural hematomas. 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J Neurointerv Surg. 2022;14(12):1279-1283."},{"issue":"8","key":"bib14","series-title":"J Neurointerv Surg","first-page":"804","article-title":"Total 1-year hospital cost of middle meningeal artery embolization compared to surgery for chronic subdural hematomas: a propensity-adjusted analysis","volume":"14","author":"Catapano","year":"2022","unstructured":"Catapano JSKoester SWSrinivasan VM, et al. Total 1-year hospital cost of middle meningeal artery embolization compared to surgery for chronic subdural hematomas: a propensity-adjusted analysis. J Neurointerv Surg. 2022;14(8):804-806."},{"issue":"10","key":"bib15","series-title":"Cureus","first-page":"e18868","article-title":"Middle meningeal artery embolization and the treatment of a chronic subdural hematoma","volume":"13","author":"D\u00e9sir","year":"2021","unstructured":"D\u00e9sir LLD\u2019Amico RLink T, et al. Middle meningeal artery embolization and the treatment of a chronic subdural hematoma. 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Acta Neurochir (Wien). 2020;162(4):777-784."},{"key":"bib18","series-title":"World Neurosurg","first-page":"57","article-title":"Middle meningeal artery embolization for chronic subdural hematomas is efficacious and cost-effective","volume":"162","author":"Pacult","year":"2022","unstructured":"Pacult MACatapano JSKoester SW, et al. Middle meningeal artery embolization for chronic subdural hematomas is efficacious and cost-effective. World Neurosurg. 2022;162:57-58."},{"issue":"5","key":"bib19","series-title":"J Neurointerv Surg","first-page":"471","article-title":"Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization","volume":"13","author":"Shapiro","year":"2021","unstructured":"Shapiro MWalker MCarroll KT, et al. Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization. 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Hereditary hemorrhagic telangiectasia: diagnosis and management from the hematologist\u2019s perspective. Haematologica. 2018;103(9):1433-1443."},{"key":"bib3","series-title":"BMJ Case Rep","first-page":"bcr2014207852","article-title":"Rare manifestations in a case of Osler-Weber-Rendu disease","volume":"2015","author":"Singh","year":"2015","unstructured":"Singh ASuri VJain SVarma S. Rare manifestations in a case of Osler-Weber-Rendu disease. BMJ Case Rep. 2015;2015:bcr2014207852."},{"key":"bib4","series-title":"Interv Neuroradiol","first-page":"15910199241246299","article-title":"Embolization of middle meningeal artery for","author":"Shankar","year":"2024","unstructured":"Shankar JAlcock SMilot G. Embolization of middle meningeal artery for chronic subdural hematoma: do we have sufficient evidence? Interv Neuroradiol. 2024:15910199241246299."},{"key":"bib5","series-title":"Clin Neurol Neurosurg","first-page":"105464","article-title":"Embolization of the middle meningeal artery in chronic subdural hematoma\u2014a systematic review","volume":"186","author":"Court","year":"2019","unstructured":"Court JTouchette CJIorio-Morin CWestwick HJBelzile FEffendi K. Embolization of the middle meningeal artery in chronic subdural hematoma\u2014a systematic review. Clin Neurol Neurosurg. 2019;186:105464."},{"issue":"2","key":"bib6","series-title":"Neurosurgery","first-page":"268","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations","volume":"88","author":"Kan","year":"2021","unstructured":"Kan PMaragkos GASrivatsan A, et al. Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations. Neurosurgery. 2021;88(2):268-277."},{"issue":"6","key":"bib7","series-title":"Neurosurgery","first-page":"801","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases","volume":"85","author":"Link","year":"2019","unstructured":"Link TWBoddu SPaine SMKamel HKnopman J. Middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases. Neurosurgery. 2019;85(6):801-807."},{"issue":"4","key":"bib8","series-title":"Radiology","first-page":"e222045","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: predictors of clinical and radiographic failure from 636 embolizations","volume":"307","author":"Salem","year":"2023","unstructured":"Salem MMKuybu ONguyen Hoang A, et al. Middle meningeal artery embolization for chronic subdural hematoma: predictors of clinical and radiographic failure from 636 embolizations. Radiology. 2023;307(4):e222045."},{"issue":"2","key":"bib9","series-title":"J Neurosurg","first-page":"332","article-title":"Nonsurgical treatment of chronic subdural hematoma with tranexamic acid","volume":"119","author":"Kageyama","year":"2013","unstructured":"Kageyama HToyooka TTsuzuki NOka K. Nonsurgical treatment of chronic subdural hematoma with tranexamic acid. J Neurosurg. 2013;119(2):332-337."},{"key":"bib10","series-title":"World Neurosurg","first-page":"29","article-title":"Tranexamic acid for treatment of residual subdural hematoma after bedside twist-drill evacuation","volume":"91","author":"Tanweer","year":"2016","unstructured":"Tanweer OFrisoli FABravate C, et al. Tranexamic acid for treatment of residual subdural hematoma after bedside twist-drill evacuation. World Neurosurg. 2016;91:29-33."},{"issue":"3","key":"bib11","series-title":"J Neurosurg","first-page":"609","article-title":"A case-comparison study of the subdural evacuating port system in treating chronic subdural hematomas","volume":"113","author":"Rughani","year":"2010","unstructured":"Rughani AILin CDumont TMPenar PLHorgan MATranmer BI. A case-comparison study of the subdural evacuating port system in treating chronic subdural hematomas. J Neurosurg. 2010;113(3):609-614."},{"issue":"6","key":"bib12","series-title":"J Korean Neurosurg Soc","first-page":"628","article-title":"Spontaneous resolution of chronic subdural hematoma: close observation as a treatment strategy","volume":"59","author":"Kim","year":"2016","unstructured":"Kim HCKo JHYoo DSLee SK. Spontaneous resolution of chronic subdural hematoma: close observation as a treatment strategy. J Korean Neurosurg Soc. 2016;59(6):628-636."},{"issue":"12","key":"bib13","series-title":"J Neurointerv Surg","first-page":"1279","article-title":"Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization","volume":"14","author":"Catapano","year":"2022","unstructured":"Catapano JSDucruet AFSrinivasan VM, et al. Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization. J Neurointerv Surg. 2022;14(12):1279-1283."},{"issue":"8","key":"bib14","series-title":"J Neurointerv Surg","first-page":"804","article-title":"Total 1-year hospital cost of middle meningeal artery embolization compared to surgery for chronic subdural hematomas: a propensity-adjusted analysis","volume":"14","author":"Catapano","year":"2022","unstructured":"Catapano JSKoester SWSrinivasan VM, et al. Total 1-year hospital cost of middle meningeal artery embolization compared to surgery for chronic subdural hematomas: a propensity-adjusted analysis. J Neurointerv Surg. 2022;14(8):804-806."},{"issue":"10","key":"bib15","series-title":"Cureus","first-page":"e18868","article-title":"Middle meningeal artery embolization and the treatment of a chronic subdural hematoma","volume":"13","author":"D\u00e9sir","year":"2021","unstructured":"D\u00e9sir LLD\u2019Amico RLink T, et al. Middle meningeal artery embolization and the treatment of a chronic subdural hematoma. Cureus. 2021;13(10):e18868."},{"issue":"9","key":"bib16","series-title":"J Neurointerv Surg","first-page":"912","article-title":"Middle meningeal artery embolization for the management of chronic subdural hematoma","volume":"11","author":"Fiorella","year":"2019","unstructured":"Fiorella DArthur AS. Middle meningeal artery embolization for the management of chronic subdural hematoma. J Neurointerv Surg. 2019;11(9):912-915."},{"issue":"4","key":"bib17","series-title":"Acta Neurochir (Wien)","first-page":"777","article-title":"Embolization of the middle meningeal artery in patients with chronic subdural hematoma\u2014a systematic review and meta-analysis","volume":"162","author":"Haldrup","year":"2020","unstructured":"Haldrup MKetharanathan BDebrabant B, et al. Embolization of the middle meningeal artery in patients with chronic subdural hematoma\u2014a systematic review and meta-analysis. Acta Neurochir (Wien). 2020;162(4):777-784."},{"key":"bib18","series-title":"World Neurosurg","first-page":"57","article-title":"Middle meningeal artery embolization for chronic subdural hematomas is efficacious and cost-effective","volume":"162","author":"Pacult","year":"2022","unstructured":"Pacult MACatapano JSKoester SW, et al. Middle meningeal artery embolization for chronic subdural hematomas is efficacious and cost-effective. 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J Stroke Cerebrovasc Dis. 2020;29(11):105273."},{"issue":"1","key":"bib21","series-title":"Trials","first-page":"56","article-title":"Tranexamic acid to prevent operation in chronic subdural haematoma (TORCH): study protocol for a randomised placebo-controlled clinical trial","volume":"23","author":"Immenga","year":"2022","unstructured":"Immenga SLodewijkx RRoos YBWEM, et al. Tranexamic acid to prevent operation in chronic subdural haematoma (TORCH): study protocol for a randomised placebo-controlled clinical trial. 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