Intraarterial Bevacizumab Administration Through the Middle Meningeal Artery for Chronic Subdural Hematoma

Chronic subdural hematoma has a rising incidence and a high burden of disability and mortality worldwide. The disease process once thought to be from an insidious venous hemorrhage is now believed to be related to chronic inflammation and angiogenesis mediated by vascular endothelial growth factor and other angiogenic factors. Middle meningeal artery embolization is being increasingly used as sole therapy or as a surgical adjunct in the management of chronic subdural hematoma. However, this treatment has risk of migration of embolic material in the presence of unrecognized anastomoses with the retina or other neural tissue. Bevacizumab is a vascular endothelial growth factor‐A receptor antagonist used in the treatment of a number of diseases. We herein report the first case of intraarterial bevacizumab injection in the middle meningeal artery for the treatment of chronic subdural hematoma.