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Middle Meningeal Artery Embolization and the Treatment of a Chronic Subdural Hematoma
Likowsky L Désir1, Randy D'Amico1, Thomas Link1
1Department of Neurological Surgery, Lenox Hill Hospital, New York City, USA.
Insights
Middle meningeal artery (MMA) embolization offers a new treatment for chronic subdural hematoma (cSDH). This minimally invasive procedure may reduce recurrence after surgery by targeting the hematoma
Area of Science:
- Neurosurgery
- Interventional Radiology
Background:
- Chronic subdural hematoma (cSDH) is a common condition, particularly in the elderly.
- Current treatments include observation for asymptomatic cases and surgical evacuation for symptomatic ones, but recurrence rates can be high.
Purpose of the Study:
- To review the existing literature on middle meningeal artery (MMA) embolization for cSDH.
- To discuss the pathophysiology of cSDH and the mechanism of MMA embolization.
Main Methods:
- Literature review of studies on MMA embolization for cSDH.
- Discussion of the vascular supply to the subdural space and the role of the MMA.
Main Results:
- MMA embolization is an emerging treatment option for cSDH.
- The procedure aims to reduce inflammation and neovascularization within the hematoma capsule.
Conclusions:
- MMA embolization presents a promising alternative or adjunct treatment for cSDH.
- Further research is needed to establish its efficacy and optimal use in clinical practice.
Abstract:
Chronic subdural hematoma (cSDH) is a common pathology that typically affects the elderly. It is believed to occur due to injury to the dural border cells, which creates an inflammation/proliferation reaction. Ineffective repair leads to the formation of a new external layer of cells and fragile capillaries, which damage easily and can worsen the condition. Conventionally, asymptomatic cSDH is managed by observation, and symptomatic cases are treated by surgical evacuation. Unfortunately, recurrence rates of the SDH following surgical evacuation can be high. One treatment option for SDH involves embolization of the middle meningeal artery (MMA). The MMA provides blood supply to the dura mater and feeds the membrane capillaries covering the SDH. MMA embolization blocks the blood flow to this system and can promote hematoma resolution. In this paper, we review the existing literature on MMA embolization and discuss the underlying pathophysiology of cSDH.
