Embolization Therapy for Refractory Hemorrhage in Patients with Chronic Subdural Hematomas

There is no definite operative procedure for patients with intractable chronic subdural hematoma (CSDH). We describe the safety and efficacy of embolization treatment of the middle meningeal artery (MMA) for such cases.

Patients were divided into an embolization group (n = 20) and a conventional group (n = 23) based on the therapeutic approach to their CSDHs. The targets of the endovascular treatment were 26 recollected hematomas with increased risk of recurrence. To eliminate the arterial supply of the external membrane of CSDHs, 2 branches of the MMA were selected and occluded by injection of polyvinyl alcohol particles.

Older age and antiplatelet drug use were comparatively related to the embolization group (P < 0.05). Among imaging study variables, severe brain atrophy and hematoma bilaterality were the risk factors for necessity of MMA embolization (P < 0.05). The complication rate and functional outcome were not significantly different between the 2 groups (P > 0.05). After multivariate analysis, early brain re-expansion (P = 0.003) and lesser hematoma recurrence (P = 0.024) remained independently associated with patients who underwent embolization therapy.

This pilot study indicated that perioperative MMA embolization could be offered as the least invasive and most effectual means of treatment for resistant patients of CSDHs with 1 or more recurrences.