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Middle Meningeal Artery Embolization for Recurrent Chronic Subdural Hematoma: A Case Series

Thomas W Link1, Justin T Schwarz1, Stephanie M Paine1

  • 1Department of Neurosurgery, Weill Cornell Medical College New York Presbyterian Hospital, New York, New York, USA.

World Neurosurgery
|September 28, 2018
PubMed
Abstract

Insights

Middle meningeal artery (MMA) embolization offers a minimally invasive treatment for chronic subdural hematoma (SDH). This procedure successfully treated 6 of 7 recurrent SDHs, allowing patients to avoid surgery and achieve symptom resolution.

Area of Science:

  • Neurosurgery
  • Interventional Radiology
  • Vascular Neurology

Background:

  • Chronic subdural hematoma (SDH) recurrence is often linked to fragile neovasculature within the hematoma membrane.
  • Distal branches of the middle meningeal artery (MMA) supply this neovasculature, leading to rebleeding.
  • Embolization of the MMA aims to occlude this blood supply, preventing recurrent SDH.

Purpose of the Study:

  • To evaluate the efficacy of middle meningeal artery (MMA) embolization in treating recurrent chronic subdural hematoma (SDH).
  • To assess the potential of MMA embolization as a minimally invasive alternative to surgical reevacuation for chronic SDH.

Main Methods:

  • Retrospective review of 6 patients with 7 recurrent chronic subdural hematomas (SDHs).
  • Treatment involved embolization of the middle meningeal artery (MMA) using polyvinyl alcohol particles.
  • Successful embolization was achieved in all patients without immediate complications.

Main Results:

  • Middle meningeal artery (MMA) embolization was technically successful in all cases.
  • One of seven treated chronic subdural hematomas (SDHs) recurred and required surgical reevacuation.
  • Six of seven SDHs demonstrated significant size reduction, and all patients experienced symptom resolution.
  • The treated SDHs showed size reductions ranging from 12 mm to 3 mm over follow-up periods of 3 to 31 weeks.

Conclusions:

  • Middle meningeal artery (MMA) embolization is a potentially effective treatment for recurrent chronic subdural hematoma (SDH).
  • This minimally invasive approach allowed 6 out of 7 patients to avoid surgical reevacuation.
  • MMA embolization represents a promising alternative to surgery for managing chronic SDH.
Keywords:
EmbolizationInterventionalMiddle meningeal arteryRecurrenceSubdural hematoma

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