Related Experiment Video
Updated: May 23, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Middle meningeal artery embolization and subdural evacuating port system placement for chronic subdural hematomas:
Ryan Gensler1, Clare Grady2, Gregory F Keating2
1Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, USA. rtg41@georgetown.edu.
Insights
Middle meningeal artery (MMA) embolization combined with subdural evacuating port systems (SEPS) offers a minimally invasive approach for chronic subdural hematoma (cSDH). This strategy aims to reduce risks and prevent recurrence.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Interventions
Background:
- Chronic subdural hematoma (cSDH) presents a significant neurosurgical challenge with high morbidity and mortality.
- Current optimal management strategies for cSDH remain a subject of debate.
- Minimally invasive techniques are sought to improve patient outcomes.
Purpose of the Study:
- To describe a novel, sequential, minimally invasive approach for managing chronic subdural hematoma.
- To evaluate the feasibility of combining middle meningeal artery (MMA) embolization with subdural evacuating port systems (SEPS).
- To present a strategy for mitigating perioperative risks in cSDH management.
Main Methods:
- A combined approach involving MMA embolization and SEPS placement was performed by a dual-trained neurosurgeon.
- Procedures were conducted sequentially in an interventional radiology suite.
- Real-time radiographic visualization using Xper-CT was utilized to monitor results.
Main Results:
- The described technique allows for minimally invasive evacuation of cSDH.
- Sequential MMA embolization and SEPS placement is technically feasible.
- The combined approach demonstrated immediate radiographic results.
Conclusions:
- MMA embolization followed by SEPS evacuation is a valuable strategy for cSDH.
- This minimally invasive approach can mitigate perioperative risks and patient comorbidities.
- The combined intervention shows promise in minimizing cSDH recurrence.
Background:
Chronic subdural hematoma (cSDH) is a common neurosurgical pathology causing significant morbidity and mortality, yet optimal management and intervention remains controversial.
Methods:
We describe embolization of the middle meningeal artery (MMA) and placement of subdural evacuating port systems (SEPS) by a dual trained open and endovascular neurosurgeon. Both procedures are done in sequence in the interventional radiology suite, and real time radiographic results are demonstrable with Xper-CT.
Conclusions:
MMA Embolization followed by evacuation of cSDH with a SEPS is a valuable strategy to mitigate perioperative risk factors and patient comorbidities, through a minimally invasive evacuation with subsequent embolization minimizing recurrence.
