Chronic headaches and middle meningeal artery embolization

2021 ◽  
pp. neurintsurg-2021-017602
Author(s):  
Joshua S Catapano ◽  
Katherine Karahalios ◽  
Visish M Srinivasan ◽  
Jacob F Baranoski ◽  
Caleb Rutledge ◽  
...  
Keyword(s):  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Telephone Call ◽  
History Of ◽  
Chronic Headaches ◽  
Gcs Score ◽  
The Relationship ◽  
Headache Impact ◽  
Meningeal Artery

BackgroundThe middle meningeal artery (MMA) has been implicated in chronic headaches, but no studies have examined the relationship between MMA embolization and headaches.MethodsPatients treated with MMA embolization for a chronic subdural hematoma (cSDH) between January 1, 2018, and December 31, 2020, were retrospectively assessed. Patients with a Glasgow Coma Scale (GCS) score of 15 at discharge received a follow-up telephone call to assess their history of chronic headache, defined as a headache ≥2 years before the cSDH and symptoms ≥2 days/month. A Headache Impact Test (HIT-6) was performed during the follow-up telephone call. The primary outcome was resolution or improvement of headaches after embolization.ResultsOf 76 patients undergoing MMA embolization for a cSDH during the study period, 56 (74%) had a discharge GCS score of 15. Of these 56 patients, 46 (82%) responded to a follow-up telephone call and were analyzed (mean [SD] age 68 [11] years; 36 [78%] men and 10 [22%] women). Nine (20%) reported chronic headaches before embolization. With a mean (SD) follow-up of 489 (173) days, eight of the nine patients reported improvement of chronic headaches, with seven having complete resolution. For these nine patients, the mean (SD) HIT-6 score was significantly higher before embolization than after embolization (64 [7.1] vs 40 [9.1], p<0.001).ConclusionIn patients with chronic headaches who underwent MMA embolization for a cSDH, the majority reported improvement of headaches after the procedure. Future prospective studies are warranted to assess the usefulness of MMA embolization to treat chronic headaches.

scholarly journals Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature

2015 ◽  
Vol 21 (3) ◽  
pp. 366-371 ◽  
Author(s):  
Akira Tempaku ◽  
Shigeru Yamauchi ◽  
Hidetoshi Ikeda ◽  
Nobuyuki Tsubota ◽  
Hironori Furukawa ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Interventional Treatment ◽  
Careful Attention ◽  
Review Of The Literature ◽  
Hematoma Formation ◽  
Polyvinyl Alcohol Particles ◽  
Meningeal Artery

Purpose Although several strategies against recurrent chronic subdural hematoma (CSDH) have been proposed, no consensus has been established. Recently, middle meningeal artery (MMA) embolization has been proposed as radical treatment for recurrent CSDH. We wanted to estimate the usefulness of MMA embolization for recurrent CSDH. Methods From February 2012 to June 2013, 110 patients with CSDH underwent single burr-hole surgery with irrigation and drainage. Among these patients, 13 showed recurrent hematoma formation and were retreated surgically. Furthermore, repeated recurrence of CSDH was observed in six patients. Five of these six patients underwent middle meningeal artery (MMA) embolization with polyvinyl alcohol particles. All five patients with interventional treatment were observed for four to 60 weeks. Results No more recurrence of CSDH was observed in any of the patients. During the follow-up period, no patients suffered from any side effects or complications from the interventional treatment. Conclusion MMA embolization with careful attention paid to the procedure might be a treatment of choice for recurrent CSDH.

scholarly journals Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations

Neurosurgery ◽  
2020 ◽  
Author(s):  
Peter Kan ◽  
Georgios A Maragkos ◽  
Aditya Srivatsan ◽  
Visish Srinivasan ◽  
Jeremiah Johnson ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Anticoagulation Therapy ◽  
Surgical Techniques ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Primary Treatment ◽  
Thickness Reduction ◽  
Hematoma Expansion ◽  
Meningeal Artery

Abstract BACKGROUND Middle meningeal artery (MMA) embolization has emerged as a promising treatment for chronic subdural hematoma (cSDH). OBJECTIVE To determine the safety and efficacy of MMA embolization. METHODS Consecutive patients who underwent MMA embolization for cSDH (primary treatment or recurrence after conventional surgery) at 15 centers were included. Clinical details and follow-up were collected prospectively. Primary clinical and radiographic outcomes were the proportion of patients requiring additional surgical treatment within 90 d after index treatment and proportion with &gt; 50% cSDH thickness reduction on follow-up computed tomography imaging within 90 d. National Institute of Health Stroke Scale and modified Rankin Scale were also clinical outcomes. RESULTS A total of 138 patients were included (mean age: 69.8, 29% female). A total of 15 patients underwent bilateral interventions for 154 total embolizations (66.7% primary treatment). At presentation, 30.4% and 23.9% of patients were on antiplatelet and anticoagulation therapy, respectively. Median admission cSDH thickness was 14 mm. A total of 46.1% of embolizations were performed under general anesthesia, and 97.4% of procedures were successfully completed. A total of 70.2% of embolizations used particles, and 25.3% used liquid embolics with no significant outcome difference between embolization materials (P &gt; .05). On last follow-up (mean 94.9 d), median cSDH thickness was 4 mm (71% median thickness reduction). A total of 70.8% of patients had &gt;50% improvement on imaging (31.9% improved clinically), and 9 patients (6.5%) required further cSDH treatment. There were 16 complications with 9 (6.5%) because of continued hematoma expansion. Mortality rate was 4.4%, mostly unrelated to the index procedure but because of underlying comorbidities. CONCLUSION MMA embolization may provide a safe and efficacious minimally invasive alternative to conventional surgical techniques.

Transradial embolization of the left middle meningeal artery and accessory middle meningeal artery for treatment of subacute–chronic subdural hematoma

2020 ◽  
Vol 12 (4) ◽  
pp. 436-436 ◽  
Author(s):  
Gary B Rajah ◽  
Michael K Tso ◽  
Rimal Dossani ◽  
Kunal Vakharia ◽  
Adnan H Siddiqui
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Middle Meningeal Artery ◽  
Vascular Lesion ◽  
External Carotid ◽  
Invasive Treatment ◽  
History Of ◽  
The Right ◽  
Meningeal Artery

This 52-year-old man with no remarkable medical history, no anticoagulation use, and no history of trauma was noted to have a subacute–chronic left subdural hematoma during outpatient headache evaluation. No occult vascular lesion or cross-calvarial supply of the right middle meningeal artery (MMA) to the left side was identified on bilateral selective external carotid injections. Because the patient preferred non-surgical management, we performed a left MMA embolization with Onyx 18 (Medtronic), utilizing a Headway Duo microcatheter (MicroVention) via the transradial route. A 6 French Benchmark (Penumbra) was utilized for transradial support into the left external carotid. The patient was discharged home the same day. Repeat scans from 2 to 6 weeks revealed complete resolution of the subdural hematoma. The patient’s headaches resolved. Transradial MMA embolization for subacute–chronic subdural hematoma represents a minimally invasive treatment option for mass effect and hemorrhage-related symptoms. Tailored embolizations are necessary when >1 meningeal vessel supplies the subdural hematoma.

Chronic subdural hematoma recurrence due to contralateral neovascularization following middle meningeal artery embolization

2021 ◽  
pp. 159101992110651
Author(s):  
Zachary S Hubbard ◽  
Sami Al Kasab ◽  
Guilherme B Porto ◽  
Alejandro Spiotta
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Diagnostic Investigation ◽  
Neurologically Intact ◽  
Radiographic Result ◽  
Radiographic Improvement ◽  
Meningeal Artery

Introduction Chronic subdural hematoma (CSDH) is one of the most commonly encountered neurosurgical diseases. Middle meningeal artery embolization (MMAE) is a technique for the management of CSDH that has elicited promising results. Despite the encouraging results of MMAE, recurrence does occur. One uncommon mechanism for recurrence of CSDH is by means of neovascularization of the contralateral middle meningeal artery (MMA). We describe two cases of CSDH recurrence by means of contralateral middle meningeal artery neovascularization treated with contralateral MMAE. Methods We identified two cases of recurrent subdural hematoma secondary to neovascularization following treatment with contralateral MMAE. Results Two patients initially treated with MMAE were identified with CSDH recurrence secondary to contralateral MMA neovascularization. There was no traumatic or coagulopathic contribution to CSDH recurrence. In both cases, patients underwent contralateral MMAE. Both patients were neurologically intact with radiographic improvement of CSDH at follow up. Conclusions Re-accumulation of SDH following MMAE by means of contralateral MMA neovascularization is a rare subtype of subdural hematoma (SDH) recurrence following MMAE. Within the context of re-accumulation of SDH following MMAE, catheter angiography is an important diagnostic investigation to elucidate the etiology of the recurrence. Furthermore, when angiography reveals neovascularization of the contralateral MMA, embolization of the contralateral MMA achieves good clinical and radiographic result.

Abstract 1122‐000098: A New Technique to Prevent Ophthalmic Complications Prior to Middle Meningeal Artery Embolization

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Kiana Moussavi ◽  
Mohammad Moussavi
Keyword(s):  
Internal Carotid ◽  
Chronic Subdural Hematoma ◽  
Invasive Procedure ◽  
Middle Meningeal Artery ◽  
Adjunctive Treatment ◽  
Artery Embolization ◽  
Main Trunk ◽  
A New Technique ◽  
Meningeal Artery

Introduction : Embolization of the Middle Meningeal Artery (MMA) is a minimally invasive procedure used as an alternative or adjunctive treatment of chronic subdural hematoma (cSDH). The benefits of MMA embolization have been attributed to targeting of the pathophysiology of cSDH which currently favors a process of increasing inflammatory response causing immature and leaky neovascularization. The major dural arteries and hazards associated with their embolization have been thoroughly described in past literature. The unintended embolization of orbital arteries leading to blindness is the most significant hazard associated with MMA embolization. The purpose of this study is to present 5 cases demonstrating the success of our technique in the treatment of cSDH while preventing the possibility of blindness by coiling the anastomotic vessel between MMA and Ophthalmic Artery (OA) branches prior to particle embolization. Methods : After doing an Internal Carotid Artery (ICA) run and ensuring the origination of the OA from the ICA and observing retinal blush, we routinely infused 10–20mcg of Nitroglycerine into the main trunk of MMA through a microcatheter to dilate and better visualize the MMA branches including anastomosis. If the meningeo‐ophthalmic collaterals were visualized during the follow‐up microcatheter run, we coil embolized the proximal segment of those collaterals through the same microcatheter. We then infused 100–300µm particles through the main branches of the MMA supplying the dura. Results : Of the 39 patients who underwent MMA embolization for cSDH, 5 received MMA/OA collateral variants coil embolization followed by successful particle embolization of all MMA branches supplying the dura without complication. Conclusions : In our cSDH patients, the collaterals from MMA to Ophthalmic or Lacrimal branches were safely coil embolized before complete particle embolization of the MMA dural branches. In a few patients these collaterals became obvious after inducing vasodilatation. None of these patients had major complications. This technique may be safer, more effective and cheaper than wedging, gluing or low pressure infusion. Our literature search did not find a similar technique used in this application.

Midterm Follow-Up of Patients with Middle Meningeal Artery Embolization in Intractable Chronic Subdural Hematoma

2019 ◽  
Vol 126 ◽  
pp. e671-e678 ◽  
Author(s):  
Yu Okuma ◽  
Nobuyuki Hirotsune ◽  
Yu Sato ◽  
Tomoyuki Tanabe ◽  
Kenichiro Muraoka ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Meningeal Artery

Abstract 1122‐000082: Outcomes of Chronic and Subacute Subdural Hemorrhages Treated with Middle Meningeal Artery Embolization

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Ahmed Elmashad ◽  
Ahmed Elmashad ◽  
Mohamad Fayad ◽  
Smit Patel ◽  
Jussie Lima ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Retrospective Chart Review ◽  
Middle Meningeal Artery ◽  
Categorical Variables ◽  
High Recurrence Rate ◽  
Artery Embolization ◽  
Significant Difference ◽  
Meningeal Artery

Introduction : Chronic subdural hematoma (cSDH) is a common neurosurgical condition with a high recurrence rate. Middle meningeal artery (MMA) embolization has been shown to reduce the incidence of re‐bleeding and prevent recurrence of cSDH by devascularizing the subdural membranes and shifting the balance from continued leakage and accumulation of blood and proteinaceous material to reabsorption. We report our single center experience of MMA embolization for treatment of chronic and subacute subdural hematoma. Methods : We performed a retrospective chart review of all patients ≥18 years who underwent MMA embolization between 01/01/2020‐03/01/2021 for cSDH. We looked at the outcomes, rate of recurrence and possible complications after MMA embolization. A descriptive analysis for continuous and categorical variables was performed using SAS 9.4 version. Results : A total of 41 MMA embolizations were performed on 32 patients with a median age of 75 (Q1‐Q3 70–83). Median hematoma thickness was 12 mm. Among them, 52% patients underwent particle embolization while 48% underwent liquid embolization. One patient had recurrence on follow up imaging and required drainage with burr hole. Three patients underwent hematoma evacuation after MMA embolization without evidence of recurrence on imaging. Three cases were aborted due to high risk or difficult access. There were no procedure related complications in the whole study population. 65% patient achieved mRS 0–2 on 90 day follow up visit. There was no significant difference between particles and liquid embolizations. Conclusions : Middle meningeal artery embolization could be used as a safe and effective intervention for prevention of recurrence and improving outcomes of subacute or chronic subdural hematoma.

scholarly journals Efficacy and mid-term outcome of middle meningeal artery embolization with or without burr hole evacuation for chronic subdural hematoma compared with burr hole evacuation alone

2021 ◽  
pp. neurintsurg-2021-017450
Author(s):  
Christina Onyinzo ◽  
Ansgar Berlis ◽  
Maria Abel ◽  
Manfred Kudernatsch ◽  
Christoph J Maurer
Keyword(s):  
Revision Surgery ◽  
Subdural Hematoma ◽  
Combined Treatment ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Burr Hole ◽  
Term Outcome ◽  
Burr Hole Evacuation ◽  
Meningeal Artery

BackgroundChronic subdural hematoma (CSDH) is a common neurosurgical condition with high recurrence rates. Repeated microbleedings from fragile neo-vessels supplied by peripheral branches of the middle meningeal artery (MMA) are believed to be responsible for the growth and recurrence of CSDH. Thus, MMA embolization might be a promising method to prevent re-bleedings and recurrences. This study aims to assess the efficacy, complication rates, and mid-term outcome of MMA embolization with or without burr hole irrigation compared with burr hole irrigation alone.MethodsPatients diagnosed with CSDH who underwent MMA embolization and/or surgical treatment were retrospectively recruited to this single-center study. The outcome variables were defined as treatment-related complications, clinical outcome at discharge, rate of revision surgery, and CT findings during the follow-up period.ResultsA total of 132 patients with CSDH were included in the study. The use of antiplatelet/anticoagulant medication was significantly higher in the combined treatment and embolization group (p<0.001). A trend towards fewer revision surgeries was found in the group of patients who received MMA embolization combined with burr hole irrigation (p=0.083). Follow-up was available for 73 patients (55.3%) with a mean follow-up period of 3.4±2.2 months. Eight patients (15.1%) of the surgery group showed hematoma re-accumulation and needed surgical rescue, whereas only one patient (5.0%) of the combined treatment group needed revision surgery. In all patients treated with only MMA embolization, complete hematoma resolution was found.ConclusionMMA embolization is a safe and efficacious minimal invasive adjuvant and/or alternative procedure for the treatment of CSDH with a reduced recurrence rate.

scholarly journals Repeated Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Management: Case Report

2021 ◽  
pp. 1-3
Author(s):  
Dimitri Sigounas ◽  
Kenneth Sack ◽  
George Thomas ◽  
Dimitri Sigounas
Keyword(s):  
Case Report ◽  
Subdural Hematoma ◽  
Coil Embolization ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
External Circulation ◽  
Meningeal Artery ◽  
Distal Flow

Aim: Middle Meningeal Artery (MMA) embolization has emerged as a viable neuroendovascular technique for the management of chronic subdural hematoma (SDH). Comparative analysis of various endovascular techniques for embolization is lacking. Guidance on operative techniques in situations of prior embolization failure is rare. Materials and Methods: In this case report, we present a patient with a chronic subdural hematoma that failed previous coil embolization of the MMA. Digital Subtraction Angiography showed the previously placed coil and continued distal flow to the dural membranes. Results: Onyx liquid embolization was completed successfully, effectively halting both anterograde flow to the MMA and retrograde flow from external circulation collaterals. Conclusion: This case report suggests that in situations of MMA embolization failure, follow-up angiography may be completed to determine if further embolization through other procedural techniques may be possible. The angiographic images contained here highlight the advantages of liquid embolization over coil embolization of the MMA in halting SDH angiogenesis.

Abstract TP38: Efficacy of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ashish Kulhari ◽  
Amrinder Singh ◽  
Siddhart Mehta ◽  
Farah Fourcand ◽  
Jawad.F. Kirmani ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Complete Resolution ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Burr Hole ◽  
Midline Shift ◽  
Artery Embolization ◽  
Burr Hole Evacuation ◽  
Meningeal Artery

Background: Symptomatic chronic subdural hematoma (SDH) is treated with surgical evacuation. SDH has a high incidence of recurrence despite evacuation, reported between 2% and 37%. Multiple case reports and case series demonstrate embolization of the Middle Meningeal artery (MMA) for the treatment of chronic SDH to be an adjunct treatment and a possible alternative to surgical evacuation. Method: Retrospective analysis of patients with chronic SDH who underwent MMA embolization at our community based, Comprehensive Stroke Center between April and August 2019 was done. MMA embolization was performed using 100-300 or 300-500 μm Embospheres. Results: 18 patients presented with chronic SDH, 55% female. Mean age and modified Rankin score was 70 (range: 48-95 years) and 1 (range: 0-3), respectively. 17 patients (94%) required a total of 20 MMA embolizations. 83% had unilateral MMA embolization and 17% had bilateral MMA embolizations. 100-300 μm Embospheres were used for the MMA embolization in 82% of the patients and 300-500 μm Embospheres in 18% of the patients. 33% had Burr hole prior to the procedure. 5% ( n= 1) patient had Burr hole evacuation after embolization due to Neurosurgeon preference, not neurological deterioration. 56 % patient received treatment to resume anticoagulation/antiplatelet and 44% received prophylactic embolization to prevent reaccumulation after Burr hole evacuation. Mean size of maximum diameter of SDH was 16.9 mm and 4.6 mm of midline shift on admission CT. Mean SDH size and midline shift at discharge was 13 mm and 2.27 respectively. 50% patients had 1 month follow up CT with mean SDH size was 8.2 mm (in comparison to 19.7 in these patients). 17 % (n=3) patients had complete resolution on 3 month follow up. The one patient treated with 300-500 μm Embospheres had an acute on chronic asymptomatic SDH on 1 month follow up CT, requiring accessory meningeal artery embolization with 100-300 μm Embospheres ultimately resulting complete resolution of the SDH at 1 month post embolization. Conclusion: Despite limited data available, Middle Meningeal artery embolization using 100-300 μm Embospheres leads to reproducible results to prevent recurrence of chronic subdural hematoma. A large randomized controlled study is needed to verify our results.

Sign in / Sign up

Export Citation Format

Share Document