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Middle meningeal artery embolization for treatment of chronic subdural hematoma
1Abteilung für diagnostische und interventionelle Radiologie, Städtisches Klinikum Lüneburg, 21339, Lüneburg, Germany. ruben.mbe@gmail.com.
Insights
Middle meningeal artery embolization shows promise for treating chronic subdural hematoma (cSDH). This procedure can be used alone or with surgery to reduce cSDH recurrence rates.
Area of Science:
- Neurosurgery
- Interventional Radiology
Background:
- Chronic subdural hematoma (cSDH) results from ruptured bridging veins in the subdural space.
- It predominantly affects older adults and is linked to risk factors like head trauma, anticoagulation therapy, and hypertension.
- Rising incidence is attributed to an aging population and increased use of anticoagulant/antiplatelet medications.
Purpose of the Study:
- To evaluate middle meningeal artery embolization as a treatment for chronic subdural hematoma.
- To assess its efficacy as a standalone therapy and as an adjunct to surgery.
Main Methods:
- Review of current treatment strategies for cSDH.
- Introduction of middle meningeal artery embolization as a therapeutic option.
- Comparison of embolization with conservative and surgical approaches.
Main Results:
- Middle meningeal artery embolization is emerging as a complementary option to surgery.
- It aims to decrease the recurrence rate of cSDH after surgical excision.
- It is also considered an alternative therapeutic approach in specific circumstances.
Conclusions:
- Embolization of the middle meningeal artery is a promising treatment for cSDH.
- It can be applied both before and after surgical excision.
- This technique offers a potential solution to reduce cSDH recurrence.
Background:
Chronic subdural hematoma (cSDH) is caused by rupture of bridging intracranial veins located in the subdural space. Predominantly, cSDH is a disease of older adults and other predisposing risk factors include minor head trauma, cerebral atrophy, antiplatelet and anticoagulation therapies, arterial hypertension, cerebrovascular atherosclerosis, diabetes mellitus, cerebrospinal fluid loss, and excessive alcohol consumption. The incidence of cSDH is rising worldwide due to an aging population and the increased use of anticoagulant or antiplatelet medications. Clinical manifestations are varied, with altered mental status and focal neurologic deficits among the most common.
Methodological Innovations:
Treatment strategies depend on the symptomatology and extent of hematoma. In general, conservative treatment is sought for patients who are asymptomatic or have only mild symptoms, whereas symptomatic patients are often treated surgically. However, the recurrence rate of cSDH may be as high as 30%. In recent years, middle meningeal artery embolization has emerged as a complementary option to surgery aimed at decreasing the recurrence rate after excision as well as an alternative therapeutic approach to surgical therapy in certain circumstances.
Conclusion:
Embolization of the middle meningeal artery appears to be a promising treatment for patients with cSDH, both before and after surgical excision.
