Middle meningeal artery embolization in chronic subdural hematoma

Chronic subdural hematoma (cSDH) is an increasingly prevalent condition, particularly among elderly population and is associated with elevated morbidity. The pathophysiology of cSDH involves proliferation of dural edge cells, fibroblasts, and release of vascular angiogenic factors leading to angiogenesis of a vascularized neomembrane perfused by the middle meningeal artery (MMA). MMA embolization is a technique that can be employed as treatment in conjunction with surgery or as a standalone therapy. Our aim is to describe our experience with treating selective cSDH patients with embolization of MMA in a university hospital in Argentina. We deployed this procedure in 6 patients over a period of one year and a half years with a median age of 72.5, with a median SDH thickness of 12.5 mm and four of them had a midline deviation greater than 5mm. The decision of the embolization was done due to minor symptoms and the necessity of restart antiplatelet therapy or anticoagulation, formal contraindication for surgery or as adjuvant of surgery because of cSDH recurrence. After discharge, no patient required a new surgical intervention. MMA embolization is impressive to be a safe and an option to treat cSDH. We present our experience in six patients in a hospital in Argentina.