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Facial nerve palsy after middle meningeal artery embolization for chronic subdural hematoma: illustrative case
Sarah Kawtharani1, Wael Shouman2, Aya Mosleh1
1Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut.
Background:
Middle meningeal artery embolization (MMAE) has emerged as a safe and effective minimally invasive alternative to surgical evacuation of chronic subdural hematoma (cSDH), both as adjuvant therapy and as a stand-alone treatment. Despite its advantages, rare complications such as facial nerve palsy (FNP) may occur. Such complications have rarely been reported in the literature in the context of cSDH, with only 7 other cases.
Observations:
The authors present the case of FNP after MMAE for cSDH and highlight the mechanism of injury, management, and preventive strategies that should be considered prior to endovascular interventions, while summarizing the previously reported cases.
Lessons:
Special attention must be given to the endovascular technique implicated and to the complex anatomy of the middle meningeal artery (MMA) to reduce the incidence of such complications. Management of such complications is extrapolated from the available literature on facial nerve injuries and is mainly supportive through eye moisturization, facial muscle rehabilitation, and steroids. Although no consensus has been reached for prevention, some recommendations have been given throughout the literature, such as distal microcatheter positioning, proximal mechanical blockage with balloon-assisted flow reversal, and the use of coil-only embolization or high-viscosity embolic agents with a particle size ≥ 150 μm. https://thejns.org/doi/10.3171/CASE25866.
Insights
Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH) can rarely cause facial nerve palsy (FNP). Careful technique and specific preventive strategies are crucial to minimize this rare complication.
Area of Science:
- Neurosurgery
- Interventional Radiology
Background:
- Middle meningeal artery embolization (MMAE) is a minimally invasive treatment for chronic subdural hematoma (cSDH).
- Facial nerve palsy (FNP) is a rare complication of MMAE.
- Only 7 previous cases of FNP following MMAE for cSDH have been reported.
Purpose of the Study:
- To present a case of FNP after MMAE for cSDH.
- To discuss the mechanism, management, and prevention of FNP after MMAE.
- To summarize existing literature on FNP following MMAE for cSDH.
Main Methods:
- Case report presentation.
- Literature review and summary of previously reported cases.
- Analysis of endovascular technique and anatomical considerations.
Main Results:
- The study presents a case of FNP following MMAE for cSDH.
- Management strategies include supportive care (eye care, rehabilitation, steroids).
- Preventive strategies discussed include distal microcatheter placement, balloon-assisted flow reversal, and specific embolic agents.
Conclusions:
- MMAE is a valuable treatment for cSDH, but FNP is a rare complication.
- Attention to endovascular technique and middle meningeal artery anatomy is vital for prevention.
- Management is supportive, while prevention strategies require further investigation and consensus.
