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Larger Middle Meningeal Arteries on Computed Tomography Angiography in Patients with Chronic Subdural Hematomas as
Arnaud Pouvelle1, Geoffroy Pouliquen1, Kevin Premat1,2
1Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
Insights
Chronic subdural hematomas (CSDHs) are linked to larger middle meningeal arteries (MMAs). This study found MMAs ipsilateral to CSDHs were significantly larger than controls, suggesting MMA involvement in CSDH development.
Area of Science:
- Neurology
- Vascular Imaging
- Neurosurgery
Background:
- Chronic subdural hematomas (CSDHs) are common head-trauma conditions.
- The middle meningeal artery (MMA) is a potential factor in CSDH pathophysiology.
- Understanding the role of the MMA in CSDH is crucial for treatment.
Purpose of the Study:
- To investigate the association between CSDHs and the size of the MMA.
- To compare MMA dimensions in CSDH patients versus controls.
- To identify potential correlations between CSDH characteristics and MMA size.
Main Methods:
- Retrospective analysis of patients undergoing CSDH embolization with pre-embolization CTAs.
- Inclusion of age- and sex-matched controls with CTAs.
- Measurement and comparison of MMA diameters: ipsilateral to CSDH, contralateral, and in controls.
Main Results:
- MMAs ipsilateral to CSDHs were significantly larger (median 1.5 mm) than control MMAs (median 1.28 mm) (p < 0.001).
- MMAs on the side of unilateral CSDHs were larger than contralateral MMAs (p < 0.001).
- Multiple surgeries in CSDH patients correlated with significantly larger MMAs (p = 0.01).
Conclusions:
- MMAs ipsilateral to CSDHs are significantly larger than contralateral MMAs and those in a control population.
- These findings suggest the MMA plays a role in the pathophysiology of CSDHs.
- Further research into MMA-targeted interventions for CSDH may be warranted.
Abstract:
Chronic subdural hematomas (CSDHs) are one of the most prevalent head-trauma-related conditions. The middle meningeal artery (MMA) may participate in the pathophysiology of CSDHs. The aim of this study was to determine whether CSDHs are associated with large MMAs. Patients referred for CSDH embolization and having undergone a computed tomography angiography (CTA) before embolization were retrospectively included. For each CSDH patient, two age- and sex-matched controls with a CTA performed during the study period were selected. Size comparisons of the MMA were performed between MMAs ipsilateral to CSDHs, on the contralateral side, and in controls. Comparison was also made with angiographic measurements from CSDH embolization procedures. Seventy-five patients with CSDH with available CTAs prior to embolization were enrolled and 146 MMAs were measured. One hundred fifty controls were included and 288 MMAs were measured. The median diameter of the 94 MMAs ipsilateral to a CSDH (1.5 mm; interquartile range [IQR] 1.3-1.7) was significantly larger than that of control MMAs (1.28 mm; IQR 1.15-1.4) (p < 0.001). The median diameter of 52 MMAs on the side of a unilateral CSDH (1.6 mm; IQR 1.4-1.8) was larger than that of the 52 contralateral MMAs (1.4 mm; IQR 1.25-1.6) (p < 0.001). Among the characteristics of patients with CSDH, multiple surgeries were associated with significantly larger MMAs (>1.7 mm; p = 0.01). MMAs ipsilateral to CSDHs appear to be significantly larger as compared with contralateral MMAs and MMAs in a control population, suggesting the involvement of the MMA in the pathophysiology of CSDH.
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