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Middle meningeal artery embolization for chronic subdural hematoma using PHIL-LV: A case series
Rudy Goh1,2, Stephen Bacchi2,3, Rebecca Scroop1
1South Australian Medical Imaging Department, Royal Adelaide Hospital, Adelaide SA, Australia.
Abstract:
BackgroundChronic subdural hematoma (CSDH) is increasingly treated with middle meningeal artery embolization (MMAE). This study evaluated MMAE using a precipitating hydrophobic injectable liquid low viscosity (PHIL-LV) liquid embolic agent under general anaesthesia.MethodsConsecutive patients who underwent MMAE for CSDH with PHIL-LV at a single comprehensive neuroscience centre during a two-year period (2023-2025) were analysed. Patient clinical characteristics, imaging characteristics and procedural characteristics were recorded and described.ResultsTwenty-two patients (mean age 76 ± 13) were included in this study. Mean CSDH size was 18.4 ± 6.7 mm; 9/22 (40.9%) patients had a Charlson Comorbidity index >4. MMA embolization was successful in all 22/22 (100%) patients. Symptomatic improvement was observed in 14/17 (82.4%) of patients. During mean follow up (10.7 ± 9.2 (range 1-36)) weeks, mean reduction in CSDH thickness was 12.1 ± 9.9 mm; 13/16 (81.3%) patients had at least partial radiologic resolution of CSDH. No patients required retreatment.ConclusionPHIL-LV MMAE was safe and effective for treatment of CSDH in this case series.
Insights
Middle meningeal artery embolization (MMAE) using PHIL-LV liquid embolic agent is safe and effective for treating chronic subdural hematoma (CSDH). This study showed successful embolization and significant symptom improvement in most patients.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Neurology
Background:
- Chronic subdural hematoma (CSDH) is a significant neurological condition.
- Middle meningeal artery embolization (MMAE) is an emerging treatment for CSDH.
- The use of PHIL-LV liquid embolic agent in MMAE for CSDH requires further evaluation.
Purpose of the Study:
- To evaluate the safety and efficacy of MMAE using PHIL-LV liquid embolic agent for CSDH treatment.
- To assess clinical and radiological outcomes in patients undergoing PHIL-LV MMAE for CSDH.
Main Methods:
- A consecutive case series of patients undergoing MMAE for CSDH with PHIL-LV was analyzed.
- Data collected included patient demographics, clinical characteristics, imaging findings, and procedural details.
- Follow-up included clinical assessment and radiological evaluation of CSDH resolution.
Main Results:
- Twenty-two patients (mean age 76) with CSDH were treated with PHIL-LV MMAE.
- Successful embolization was achieved in 100% of patients.
- 82.4% of patients experienced symptomatic improvement, and 81.3% showed radiological resolution of CSDH without need for retreatment.
Conclusions:
- PHIL-LV MMAE is a safe and effective treatment option for CSDH.
- This technique offers a promising minimally invasive approach for CSDH management.
- Further research with larger cohorts is warranted to confirm these findings.
