Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Case Series

✓ The authors present a case of refractory chronic subdural hematoma (CSH) in a 59-year-old man with coagulopathy due to liver cirrhosis. The patient was successfully treated by embolization of the middle meningeal artery after several drainage procedures. This new therapeutic approach to recurrent CSH is discussed.

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Transradial middle meningeal artery embolization for chronic subdural hematoma using Onyx: case series

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016185 ◽

2020 ◽

pp. neurintsurg-2020-016185

Author(s):

Gary B Rajah ◽

Muhammad Waqas ◽

Rimal H Dossani ◽

Kunal Vakharia ◽

Andrew D Gong ◽

...

Keyword(s):

Subdural Hematoma ◽

Conscious Sedation ◽

Case Series ◽

Chronic Subdural Hematoma ◽

Antiplatelet Agents ◽

Middle Meningeal Artery ◽

Complication Rates ◽

Femoral Access ◽

Guide Catheter ◽

Meningeal Artery

BackgroundMiddle meningeal artery (MMA) embolization is an emerging therapy for the resolution of subacute or chronic subdural hematoma (CSDH). CSDH patients are often elderly and have several comorbidities. We evaluated our experience with transradial access (TRA) for MMA embolization using predominantly Onyx under conscious sedation.MethodsData for consecutive patients who underwent transradial MMA embolization for CSDH during a 2-year period (2018–2019) were analyzed from a single-center, prospectively-maintained database. Patient demographics, comorbidities, ambulatory times, subdural hematoma resorption status, and guide catheter type were recorded. Conversion to femoral access and complication rates were also recorded. Univariate and multivariate analyses were performed.ResultsForty-six patients (mean age, 71.7±14.4 years) were included in this study. Mean CSDH size was 14±5.5 mm. Most (91.3%) TRA embolizations were performed with 6-French 0.071-inch Benchmark guide catheters (Penumbra). MMA embolization was successful in 44 patients (95.7%) (including two cases of TRA conversion). Twenty-one (48%) patients had a severe Charlson Comorbidity Index (>5). Symptomatic improvement was noted in 39 of 44 patients (88.6%). Mean length of stay was 4±3 days. Patients were ambulated immediately postprocedure. At mean follow-up (8±4 weeks), 86.4% of patients had complete or partial CSDH resolution. Persistent use of antiplatelet agents after the procedure was associated with failed or minimal CSDH resorption (5 of 6, 83.3% vs 9 of 38 23.7% with complete or near-complete resolution; P=0.009).ConclusionTransradial Onyx MMA embolization under conscious sedation is safe and effective for CSDH treatment. TRA may be especially useful in elderly patients with numerous comorbidities.

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Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016552 ◽

2020 ◽

pp. neurintsurg-2020-016552

Author(s):

Joshua S Catapano ◽

Andrew F Ducruet ◽

Candice L Nguyen ◽

Jacob F Baranoski ◽

Tyler S Cole ◽

...

Keyword(s):

Subdural Hematoma ◽

Complete Resolution ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Artery Embolization ◽

Embolic Material ◽

Ethylene Vinyl Alcohol ◽

Single Center Experience ◽

Meningeal Artery ◽

Single Branch

BackgroundRecently, middle meningeal artery (MMA) embolization has emerged as a potentially safe and effective method of treating chronic subdural hematoma (cSDH).ObjectiveTo report a single-center experience with MMA embolization and examines the type of embolic material used, the extent of penetration, and the number of MMA branches embolized.MethodsA retrospective analysis of all patients with MMA embolization from 2018 through 2019 was performed. A failed outcome was defined as either surgical rescue and/or greater than 10 mm of hematoma residual or reaccumulation following embolization.ResultsOf 35 patients, surgery had failed for 9 (26%) and initial conservative treatment had failed for 6 (17%). Of 41 MMA embolizations, including those in six patients with bilateral cSDH who underwent bilateral MMA embolization, 29 (72%) were performed using ethylene vinyl alcohol copolymer (Onyx), 7 (17%) using particles, and 5 (12%) using n-butyl cyanoacrylate. Both the anterior and posterior MMA divisions were embolized in 29 cases (71%); distal penetration of these branches was achieved in 25 embolizations (61%). Twenty-six (63%) cSDHs completely resolved. Complete resolution was seen in 22 of 29 hematomas (76%) in which both anterior and posterior MMA branches were occluded versus 4 of 12 (33%) following single-branch embolization (p=0.014). Embolization of one cSDH (2%) failed.ConclusionMMA embolization of cSDHs appears to be both safe and efficacious. Furthermore, embolization of both the anterior and posterior MMA branches may be associated with increased odds of complete resolution.

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