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Published on: July 21, 2013
Middle meningeal artery embolization: A scoping review of trends and outcomes by embolization material
Tiffany Chu1, Ryan Sindewald2, Lauren E Stone3
1Department of Neurologic Surgery, Creighton University School of Medicine, Omaha, Nebraska, United States.
Insights
Middle meningeal artery embolization is a safe and effective treatment for chronic subdural hematomas (cSDHs) with low recurrence rates. Further research is needed to determine the best embolization materials for cSDH treatment.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Neurology
Background:
- Chronic subdural hematomas (cSDHs) are common in the elderly and incidence is rising.
- Minimally invasive middle meningeal artery embolization is an alternative to surgery for cSDH.
- Efficacy of different embolization materials for cSDH is not well-established.
Purpose of the Study:
- To assess outcomes of various embolization materials used in middle meningeal artery embolization for cSDH.
- To evaluate recurrence rates and complications associated with different embolization materials.
Main Methods:
- Scoping review of studies published through August 2023.
- Analysis of 25 studies reporting 1579 embolizations in 1362 patients.
- Categorization of embolic materials: particles, liquid embolisates, coils, and combinations.
Main Results:
- Low overall recurrence rate of 5.1% after embolization.
- Most common complications included seizures and strokes.
- Overall mortality was 1.4%, with three procedure-related deaths.
Conclusions:
- Middle meningeal artery embolization demonstrates safety and efficacy for cSDH treatment.
- Data limitations prevent linking specific materials to recurrence or complication rates.
- Further large-scale studies are warranted to evaluate the safety profiles of different embolization materials.
Background:
Chronic subdural hematomas (cSDHs), blood collections under the dural layer of the brain, are common in the elderly and frequently linked to trauma and anticoagulation. As the global elderly population increases, the incidence of cSDH is expected to rise, straining healthcare systems. Middle meningeal artery embolization is a minimally invasive alternative to surgery, which could prove especially beneficial for elderly patients with multiple comorbidities or contraindications to surgery. However, the efficacy and patient-related outcomes associated with different embolization materials remain unknown.
Methods:
The authors conducted a scoping review of manuscripts published through August 2023 to assess outcomes associated with various embolization materials used in middle meningeal artery embolization for cSDH. Recurrence rates after embolization and complications were the primary outcomes.
Results:
The authors analyzed a total of 25 studies, reporting 1579 embolizations in 1362 patients. Embolic materials included particles (35.7%), liquid embolisates (31.5%), coils (3.2%), and combinations of the aforementioned materials (29.6%). Recurrence rates were low (5.1%), and the most common complications were seizures and strokes. The overall mortality was 1.4%, with three procedure-related deaths.
Conclusion:
With low recurrence and complication rates, middle meningeal artery embolization is a safe and effective treatment for cSDH. However, due to limitations in data availability, we were not able to link hematoma recurrence or complication rates with the type of embolization material used. To better understand the safety profiles of different materials, further large-scale studies are warranted.
