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Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas
Takao Hashimoto1, Tomoo Ohashi, Daisuke Watanabe
1Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjyuku Shinjyukuku Tokyo 160-0023, Japan.
Background:
Chronic subdural hematoma (CSDH) is generally treated by burr hole irrigation. However, sometimes repeated recurrence is observed, and treatment may consequently become difficult. We examined the efficacy of embolization of the middle meningeal artery (MMA) for such cases.
Methods:
We considered embolization of the MMA for three patients who had refractory CSDH with repeated recurrence and two CSDH patients who were at risk of recurrence and showed signs of recurrence after surgery. A microcatheter was advanced through the MMA as peripherally as possible, and embolization was performed with 15-20% n-butyl-2-cyanoacrylate or 200 μm polyvinyl alcohol particles.
Results:
EMBOLIZATION WAS PERFORMED IN THE THREE PATIENTS WHO HAD REFRACTORY CSDH WITH REPEATED RECURRENCE: The procedure was performed after burr hole irrigation of the hematoma in two patients and before the irrigation in one patient. In the two CSDH patients at risk of recurrence, embolization was performed when signs of recurrence appeared. The timing of embolization differed for each patient. However, in all the patients, the hematoma tended to decrease in size, and no recurrence was observed.
Conclusion:
Embolization of the MMA is effective for refractory CSDH or CSDH patients with a risk of recurrence, and is considered an effective therapeutic method to stop hematoma enlargement and promote resolution.
Insights
Middle meningeal artery (MMA) embolization effectively treats chronic subdural hematoma (CSDH) that repeatedly recurs or is at risk of recurrence. This minimally invasive procedure helps reduce hematoma size and prevent further CSDH development.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Surgery
Background:
- Chronic subdural hematoma (CSDH) management often involves burr hole irrigation.
- Recurrent CSDH presents treatment challenges, necessitating alternative therapeutic strategies.
Purpose of the Study:
- To evaluate the efficacy of middle meningeal artery (MMA) embolization for refractory CSDH.
- To assess MMA embolization in patients with CSDH at high risk of recurrence.
Main Methods:
- MMA embolization was performed using a microcatheter in five patients.
- Embolization agents included n-butyl-2-cyanoacrylate or polyvinyl alcohol particles.
- Procedures were conducted before or after burr hole irrigation, or upon recurrence signs.
Main Results:
- All treated patients showed a decrease in hematoma size.
- No recurrence of CSDH was observed post-embolization.
- The timing of embolization varied but outcomes were consistently positive.
Conclusions:
- MMA embolization is an effective treatment for refractory CSDH.
- This method is also beneficial for CSDH patients at risk of recurrence.
- Embolization successfully halts hematoma enlargement and promotes resolution.
