Endovascular Treatment of a Traumatic Pseudo Aneurysm of the Middle Meningeal Artery

OBJECTIVEChronic subdural hematoma (CSDH) is one of the most common neurosurgical pathologies, typically affecting the elderly. Its incidence is expected to grow along with the aging population. Surgical drainage represents the treatment of choice; however, postoperative complications and the rate of recurrence are not negligible. For this reason, nonsurgical alternatives (such as middle meningeal artery embolization, steroids, or tranexamic acid administration) are gaining popularity worldwide and need to be carefully evaluated, especially in the elderly population.METHODSThe authors performed a systematic review according to PRISMA criteria of the studies analyzing the nonsurgical strategies for CSDHs. They collected all papers in the English language published between 1990 and 2019 by searching different medical databases. The chosen keywords were “chronic subdural hematoma,” “conservative treatment/management,” “pharmacological treatment,” “non-surgical,” “tranexamic acid,” “dexamethasone,” “corticosteroid,” “glucocorticoid,” “middle meningeal artery,” “endovascular treatment,” and “embolization.”RESULTSThe authors ultimately collected 15 articles regarding the pharmacological management of CSDHs matching the criteria, and 14 papers included the endovascular treatment.CONCLUSIONSThe results showed that surgery still represents the mainstay in cases of symptomatic patients with large CSDHs; however, adjuvant and alternative therapies can be effective and safe in a carefully selected population. Their inclusion in new guidelines is advisable.

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Arteriovenous Fistula of the Middle Meningeal Artery—A Rare Complication After Arthroscopic Temporomandibular Joint Surgery Readily Amenable to Endovascular Treatment

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2014.03.007 ◽

2014 ◽

Vol 72 (7) ◽

pp. 1258-1265 ◽

Cited By ~ 5

Author(s):

Raphael H. Sacho ◽

Bohdan Kryshtalskyj ◽

Timo Krings

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Temporomandibular Joint ◽

Rare Complication ◽

Middle Meningeal Artery ◽

Joint Surgery ◽

Meningeal Artery ◽

Temporomandibular Joint Surgery

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Endovascular Treatment of Hemifacial Spasm Associated with a Petrosal DAVF Using Transarterial Onyx Embolization

Interventional Neuroradiology ◽

10.1177/159101991201800109 ◽

2012 ◽

Vol 18 (1) ◽

pp. 69-73 ◽

Cited By ~ 2

Author(s):

T. Li ◽

X. Lv ◽

Z. Wu

Keyword(s):

Complete Remission ◽

Facial Nerve ◽

Endovascular Treatment ◽

Hemifacial Spasm ◽

Dural Arteriovenous Fistula ◽

Middle Meningeal Artery ◽

Vascular Compression ◽

The Right ◽

Meningeal Artery

This paper reports that decompression of the facial nerve by transarterial Onyx embolization may relieve hemifacial spasm (HFS) caused by dilated veins due to a right petrosal dural arteriovenous fistula (DAVF). A 56-year-old man suffered severe chronic right HFS associated with a dilated right petrosal vein lying in the vicinity of the facial nerve. The right petrosal DAVF was reached through the middle meningeal artery using a transfemoral arterial approach and was occluded with Onyx 18 (M.T.I.- ev3, Irvine, CA, USA). There was complete remission of HFS without recurrence after two months of follow-up. This case supports vascular compression in the pathogenesis of HFS and suggests that facial nerve injury caused by a DAVF could be treated with transarterial Onyx embolization.

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Experience in Endovascular Treatment of Recurrent Chronic Subdural Hematoma

Interventional Neuroradiology ◽

10.1177/15910199070130s121 ◽

2007 ◽

Vol 13 (1_suppl) ◽

pp. 141-144 ◽

Cited By ~ 37

Author(s):

H. Ishihara ◽

S. Ishihara ◽

S. Kohyama ◽

F. Yamane ◽

M. Ogawa ◽

...

Keyword(s):

Endovascular Treatment ◽

Blood Supply ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Good Alternative ◽

Good Recovery ◽

Alternative Modality ◽

Meningeal Artery

Most cases with chronic subdural hematoma (CSDH) are treated by simple irrigation and drainage, then more than eighty percent of them result in good recovery. But we sometimes encounter intractable cases with hematoma re-collection, which is considered of repeated bleeding from macrocapillary in the hematoma capsule. Embolization of the middle meningeal artery (MMA) is considered to be useful to eliminate the blood supply to this structure. The authors experienced seven cases of intractable CSDH treated by MMA embolization and no recurrence took place in all cases for up to 15 months. Endovascular treatment may be a good alternative modality for recurrent CSDH.

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Endovascular Treatment of Chronic Subdural Hematoma with Middle Meningeal Artery Embolization

World Neurosurgery ◽

10.1016/j.wneu.2021.08.058 ◽

2021 ◽

Vol 155 ◽

pp. 193-195

Author(s):

Natasha Ironside ◽

Ching-Jen Chen ◽

Daniel Raper ◽

Dale Ding

Keyword(s):

Endovascular Treatment ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Artery Embolization ◽

Meningeal Artery

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Endovascular treatment of cribriform plate dural arteriovenous fistulas: technical difficulties and complications avoidance

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011956 ◽

2015 ◽

Vol 8 (9) ◽

pp. 954-958 ◽

Cited By ~ 16

Author(s):

Thomas Robert ◽

Raphaël Blanc ◽

Stanislas Smajda ◽

Gabriele Ciccio ◽

Hocine Redjem ◽

...

Keyword(s):

Endovascular Treatment ◽

Venous Drainage ◽

Middle Meningeal Artery ◽

Cribriform Plate ◽

Embolic Agent ◽

Arteriovenous Fistulas ◽

Technological Advances ◽

Embolic Agents ◽

Ethmoidal Artery ◽

Meningeal Artery

ObjectiveCribriform plate dural arteriovenous fistula (dAVF) is a rare pathology, for which the treatment of choice used to be neurosurgery. Technological advances in micro-catheters and embolic agents permitted new endovascular alternatives.MethodsWe included all patients treated endovascularly for a cribriform plate dAVF between 2008 and 2013. We retrospectively analysed data focusing on the type of treatment chosen.ResultsTen patients were treated by endovascular approach, with a need for an additional surgical exclusion of the fistula in two cases. Thirteen embolisation sessions were done. Embolisation of the fistula through an ethmoidal artery was the technique of choice; the catheterism of the ophthalmic artery was impossible in two cases and the embolic agent did not penetrate in four cases. The embolisation through the middle meningeal artery was successful in one case but the tortuosity of this artery prevented good penetration of the embolic agent. Venous approach was successful in all cases but was limited to fistulas with superficial venous drainage.ConclusionsEndovascular treatment of cribriform plate dAVF is safe and effective. The embolisation through ethmoidal artery is the method of choice. Branches of the middle meningeal artery are tortuous and prevent the penetration of embolic agent. Venous approach is effective but is limited to cases of failure of the arterial approach.

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