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Middle meningeal artery embolization for chronic subdural hematoma
Malgorzata Maciaszek1, Brendan Steinfort1,2, Timothy Harrington1,2
1Royal North Shore Hospital, St Leonards, New South Wales, Australia.
BMJ Surgery, Interventions, & Health Technologies
|April 1, 2025
Summary
Middle meningeal artery (MMA) embolization is a safe treatment for chronic subdural hematomas (cSDH). This procedure may reduce cSDH recurrence when used with surgery or alone.
Area of Science:
- Neurosurgery
- Interventional Radiology
Background:
- Chronic subdural hematomas (cSDH) can lead to significant morbidity.
- Middle meningeal artery (MMA) embolization is an emerging treatment option for cSDH.
Purpose of the Study:
- To evaluate recurrence rates, procedural outcomes, and patient outcomes after MMA embolization for cSDH.
- To compare MMA embolization as a sole treatment versus an adjunct to surgical evacuation.
Main Methods:
- A retrospective case series of 13 adult patients with 17 cSDHs treated at two Australian neurosurgical centers.
- MMA embolization was performed via femoral access using various embolic agents, either alone or combined with surgical evacuation.
Main Results:
- No procedural complications were observed.
- Combined embolization and surgical evacuation significantly reduced hematoma size (p<0.01).
- Embolization alone resulted in stable hematoma size (p=0.20), with a 15.4% recurrence rate requiring further intervention.
Conclusions:
- MMA embolization is a safe adjunctive or sole treatment for cSDH.
- Treatment failure may be linked to unilateral embolization or incomplete embolization.
- Further large randomized trials are needed to confirm safety and efficacy.
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