Middle meningeal artery embolization following burr hole in chronic subdural hematoma

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.

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E-111 Chronic subdural hematoma recurrence due to contralateral neovascularization following middle meningeal artery embolization

10.1136/neurintsurg-2021-snis.206 ◽

2021 ◽

Author(s):

Z Hubbard ◽

S Al Kasab ◽

G Porto ◽

M Sattur ◽

A Spiotta

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Artery Embolization ◽

Meningeal Artery

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Letter to the Editor Regarding: “Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Meta-Analysis and Systematic Review”

World Neurosurgery ◽

10.1016/j.wneu.2018.12.138 ◽

2019 ◽

Vol 124 ◽

pp. 480-481

Author(s):

Daniele Starnoni ◽

Lorenzo Giammattei ◽

Mahmoud Messerer ◽

Roy Thomas Daniel

Keyword(s):

Systematic Review ◽

Subdural Hematoma ◽

Meta Analysis ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Artery Embolization ◽

Letter To The Editor ◽

Meningeal Artery

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Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Radiology ◽

10.1148/radiol.2017170053 ◽

2018 ◽

Vol 286 (3) ◽

pp. 992-999 ◽

Cited By ~ 46

Author(s):

Seung Pil Ban ◽

Gyojun Hwang ◽

Hyoung Soo Byoun ◽

Tackeun Kim ◽

Si Un Lee ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Artery Embolization ◽

Meningeal Artery

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Middle meningeal artery embolization for refractory chronic subdural hematoma

Journal of Neurosurgery ◽

10.3171/jns.2000.93.4.0686 ◽

2000 ◽

Vol 93 (4) ◽

pp. 686-688 ◽

Cited By ~ 46

Author(s):

Shinya Mandai ◽

Masaru Sakurai ◽

Yuzo Matsumoto

Keyword(s):

Liver Cirrhosis ◽

Subdural Hematoma ◽

Therapeutic Approach ◽

Chronic Subdural Hematoma ◽

Middle Meningeal Artery ◽

Artery Embolization ◽

Content Type ◽

Meningeal Artery ◽

Fine Print

✓ 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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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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