PMC9699867_01
Coronal computed tomography (CT) head imaging of the patient at (a) initial presentation and (b) 2-week follow-up, after discharge from her subdural evacuation and middle meningeal embolization. Initial presentation demonstrated a 15 mm midline shift. Final follow-up CT described a 3 mm midline shift.
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F1
SDH with 9 mm midline shift (MLS; [Figure 1]). She was at first managed conservatively with outpatient follow-up but returned after 1 week for worsening headache, confusion, and aphasia.
Coronal CT head imaging of the patient immediately before (a) and after (b) subdural evacuation port system (SEPS) placement. The subdural hemorrhage and midline shift decreased from 2.1 cm to 1.7 cm and 12 mm to 11 mm, respectively.
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F2
She had a frontal SEPS drainage placement and a postprocedural CT head showed interval decrease in the SDH to 1.7 cm with an 11 mm MLS [Figure 2].
Dual subtraction angiography of the left external carotid from (a) lateral and (b) anterior-posterior views following SEPS drainage demonstrating the anterior left middle meningeal artery supplying a postsurgical arteriovenous fistula with drainage into the left middle meningeal vein, without cortical venous drainage.
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F3
The following day, she underwent a middle meningeal artery (MMA) embolization, where a MMA to middle meningeal vein (MMV) dAVF at the site of SEPS placement was identified [Figure 3].