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Middle Meningeal Artery Embolization for Chronic Subdural Hematoma
Seung Pil Ban1, Gyojun Hwang1, Hyoung Soo Byoun1
1From the Department of Neurosurgery, Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (S.P.B., T.K., S.U.L., J.S.B., J.H.H., C.Y.K., O.K.K., C.W.O.); and Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, 12 Beodeunaru-ro 7-gil, Yeongdeungpo, Seoul 07247, Korea (G.H., H.S.B.).
Middle meningeal artery (MMA) embolization significantly reduces treatment failure and the need for surgical rescue in chronic subdural hematoma (CSDH) patients compared to conventional treatments, demonstrating its effectiveness.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Surgery
Background:
- Chronic subdural hematoma (CSDH) presents a significant clinical challenge, often requiring invasive interventions.
- Conventional treatments for CSDH include observation, surgical evacuation, and medication, each with varying success rates and complication profiles.
- The role of middle meningeal artery (MMA) embolization as a minimally invasive treatment for CSDH is an area of ongoing research.
Purpose of the Study:
- To evaluate the therapeutic effect of middle meningeal artery (MMA) embolization on chronic subdural hematoma (CSDH).
- To compare the treatment outcomes, including failure rates and complication profiles, of MMA embolization versus conventional treatment modalities for CSDH.
Main Methods:
- A prospective study enrolled 72 patients (≥20 years) with CSDH undergoing MMA embolization, either solely or combined with hematoma removal.
- A historical control group of 469 patients treated conventionally (observation or hematoma removal) was used for comparison.
- Treatment failure, defined as incomplete resolution or reaccumulation requiring surgical rescue, and complications were assessed at six months using logistic regression analysis.
Main Results:
- MMA embolization demonstrated a significantly lower treatment failure rate (1.4% vs 27.5%) and reduced need for surgical rescue (1.4% vs 18.8%) compared to conventional treatment.
- All asymptomatic patients (n=27) treated with embolization alone achieved spontaneous hematoma resolution.
- No significant difference in treatment-related complication rates was observed between the MMA embolization and conventional treatment groups.
Conclusions:
- Middle meningeal artery (MMA) embolization is a highly effective treatment for chronic subdural hematoma (CSDH), offering superior outcomes to conventional approaches.
- MMA embolization significantly decreases the likelihood of treatment failure and the necessity for repeat surgical interventions in CSDH management.
- The procedure is associated with a comparable safety profile to conventional treatments, supporting its consideration as a primary therapeutic option for CSDH.
