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Adjunct Surgical Middle Meningeal Artery Obliteration for Recurrent Chronic Subdural Hematoma: Case Series and
Thomas Petutschnigg1, Andreas Raabe, Philippe Schucht
1Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern , Switzerland.
Insights
Navigated surgical obliteration of the middle meningeal artery (soMMA) offers a new approach to managing recurrent chronic subdural hematoma (CSH). This safe and effective technique prevents recurrence, restoring patient function.
Area of Science:
- Neurosurgery
- Interventional Neurology
Background:
- Recurrence of chronic subdural hematoma (CSH) after surgery presents a significant clinical challenge.
- Middle meningeal artery (MMA) embolization is an emerging adjunctive therapy to decrease CSH recurrence.
Purpose of the Study:
- To evaluate navigated surgical obliteration of the MMA (soMMA) via a third burr hole as an alternative treatment for recurrent CSH.
Main Methods:
- Retrospective analysis of 4 patients with recurrent symptomatic CSH undergoing revision surgery.
- soMMA performed via an additional navigated pterional burr hole, adhering to Preferred Reporting of Case Series in Surgery guidelines.
Main Results:
- All 4 patients were elderly males with comorbidities presenting with recurrent CSH.
- soMMA was safely integrated into the surgical workflow with no reported recurrences post-procedure.
- Patients achieved full functional recovery and remained asymptomatic at follow-up.
Conclusions:
- Navigated adjunct soMMA through a pterional burr hole is a viable and cost-effective option for recurrent CSH management.
- This technique is particularly beneficial for patients with contraindications to endovascular MMA embolization or in centers without endovascular capabilities.
Background And Objectives:
Recurrence after surgical treatment of chronic subdural hematoma (CSH) remains a clinical challenge. Endovascular occlusion of the middle meningeal artery (MMA) through embolization has emerged as an adjunctive procedure to reduce recurrence. We present a case series in which we performed navigated surgical obliteration of the MMA (soMMA) through a third burr hole as an alternative treatment.
Methods:
In line with the Preferred Reporting of Case Series in Surgery guidelines for surgical case series, we retrospectively analyzed 4 patients with symptomatic recurrent CSH, who received for revision an additional navigated pterional burr hole for soMMA. We report the surgical anatomy, technical considerations, clinical outcomes and potential indications.
Results:
All patients were male, multimorbid, with a mean age of 83 years, and presented with recurrent symptomatic unilateral or bilateral CSH. Revision with adjunct soMMA was performed between 10 and 90 days after index surgery. soMMA was safe, easily integrated into the workflow, and no further recurrences occurred. All patients regained full function and remained asymptomatic at last follow-up.
Conclusion:
Navigated adjunct soMMA through a pterional burr hole is a viable and cost-effective option for the management of recurrent CSH. This technique may be especially valuable for patients with contraindications for endovascular MMA embolization and for centers lacking endovascular resources.
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