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Recent Advances and Future Directions in Middle Meningeal Artery Embolization for Chronic Subdural Hematomas
Gary Kocharian1, Kyle B Zappi2, Joseph Carnevale2
1Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 E 68thSt., M-220, Box 99, New York, NY, 10065, USA. gak2007@nyp.org.
Insights
Middle meningeal artery (MMA) embolization significantly reduces chronic subdural hematoma (cSDH) recurrence to under 5%, offering a safe and minimally invasive treatment option. This procedure is particularly beneficial for high-risk patients and is poised to become a standard cSDH management strategy.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Surgery
Background:
- Chronic subdural hematomas (cSDH) represent a significant clinical challenge, often requiring intervention.
- Recurrence rates after traditional surgical evacuation can be substantial, exceeding 30%.
Purpose of the Study:
- To review the background of cSDH and the role of middle meningeal artery (MMA) embolization.
- To demonstrate the efficacy of MMA embolization in decreasing cSDH recurrence based on current literature.
Main Methods:
- Systematic review of the most up-to-date literature on MMA embolization for cSDH.
- Analysis of data from retrospective studies, systematic reviews, and prospective dual-arm studies.
Main Results:
- MMA embolization is a safe procedure with low complication and recurrence rates (<5%).
- It is effective alone or as an adjunct to surgery, particularly in elderly patients, those on anti-platelet agents, or with coagulopathies.
- The procedure is minimally invasive, can be performed awake, and avoids general anesthesia.
Conclusions:
- MMA embolization demonstrates significant safety and efficacy in managing cSDH.
- Ongoing clinical trials are expected to further solidify its role as a standard of care.
- This technique offers a less invasive alternative to traditional surgical evacuation for cSDH.
Purpose Of Review:
The purpose of this review is to present a brief background on chronic subdural hematomas (cSDH), middle meningeal artery (MMA) embolization, and its role in decreasing recurrence of cSDH. A review of the most up-to-date literature should demonstrate the efficacy of this procedure.
Recent Findings:
The latest data shows that MMA embolization is a safe procedure, with low complication rates and low recurrence rates. While cSDH managed with surgical evacuation can have a recurrence rate upwards of 30%, MMA embolization alone or as an adjunct to surgery decreases recurrence to less than 5% in most studies. MMA embolization can be especially useful in high-risk populations such as the elderly, patients on anti-platelet medication, and those with coagulopathies. It can also be done awake, done without general anesthesia, and is significantly less invasive than traditional surgical techniques. In reviewing the literature on MMA embolization, it is clear that there are numerous retrospective studies and systematic reviews demonstrating its safety and efficacy, and some prospective dual-arm studies that present novel information. The numerous clinical trials that are currently underway should help to further establish MMA embolization as standard of care in the management of cSDH.
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