1
|
Ma L, Hoz SS, Doheim MF, Fadhil A, Sultany A, Al-Bayati AR, Nogueira RG, Lang MJ, Gross BA. Impact of Embolisate Penetration, Type, and Technique on Results After Standalone Middle Meningeal Artery Embolization for Chronic Subdural Hematoma. Neurosurgery 2024:00006123-990000000-01208. [PMID: 38860780 DOI: 10.1227/neu.0000000000003023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/05/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Middle meningeal artery embolization (MMAE) has emerged as a promising modality for chronic/subacute subdural hematoma treatment; however, consensus regarding embolization technique and embolisate has not been achieved. We thus sought to compare the efficacy of distinct MMAE techniques and embolisate. METHODS An institutional registry was reviewed to identify patients undergoing standalone MMAE for symptomatic chronic/subacute subdural hematoma. Surgical rescue rate and time preceding 50% hematoma resolution were evaluated across 3 technical groups: aggressive penetration (AP), nonaggressive penetration with proximal coil embolization (NP-PC), and nonaggressive penetration alone (NP). Effect sizes were adjusted for demographic, neurological and radiological features through multivariable logistic and Cox regression. RESULTS Among 117 procedures, 33.3% achieved AP, 36.8% had NP-PC, and 29.9% had NP. The rate of surgical rescue was 2.6% after AP, 9.3% for NP-PC, and 11.4% for NP. In patients not undergoing rescue surgery, 82.4% achieved hematoma resolution ≥50% at a median imaging follow-up of 56 days; AP or NP-PC were each statistically significantly associated with enhanced hematoma resolution as compared with NP (P = .02). Similarly, sensitivity analysis within medium-size hematoma and antiplatelet/anticoagulation-at-admission subgroups revealed a superiority of resolution after AP or NP-PC. A unique, comparative secondary analysis of liquid embolisate (Onyx vs n-butyl cyanoacrylate) revealed no impact on rate of surgical rescue or hematoma resolution. CONCLUSION AP was associated with the lowest rate of surgical rescue, while both AP and NP-PC were associated with improved rates of hematoma resolution.
Collapse
Affiliation(s)
- Li Ma
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Samer S Hoz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mohamed F Doheim
- Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ali Fadhil
- Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Abdullah Sultany
- Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael J Lang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
2
|
Macêdo LPD, Araújo MGFD, Guerra PLN, Marques MASS, Silva JLJ. Middle meningeal artery embolization contraindication when it originates from the ophthalmic artery. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-2. [PMID: 38641341 PMCID: PMC11031251 DOI: 10.1055/s-0044-1786023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/22/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Lívio Pereira de Macêdo
- Hospital da Restauração, Departamento de Neurocirurgia, Recife PE, Brazil.
- Hospital da Restauração, Departamento de Neurorradiologia Intervencionista, Recife PE, Brazil.
- ANGIORAD, Departamento de Radiologia Neurointervencionista, Recife PE, Brazil.
| | | | | | - Marcos Alcino Soares Siqueira Marques
- Hospital da Restauração, Departamento de Neurocirurgia, Recife PE, Brazil.
- Hospital da Restauração, Departamento de Neurorradiologia Intervencionista, Recife PE, Brazil.
| | - José Laércio Júnior Silva
- Hospital da Restauração, Departamento de Neurocirurgia, Recife PE, Brazil.
- Hospital da Restauração, Departamento de Neurorradiologia Intervencionista, Recife PE, Brazil.
- ANGIORAD, Departamento de Radiologia Neurointervencionista, Recife PE, Brazil.
| |
Collapse
|
3
|
Rojas-Villabona A, Mohamed S, Kennion O, Padmanabhan R, Siddiqui A, Prasad M, Mukerji N. A systematic review of middle meningeal artery embolization for minimally symptomatic chronic subdural haematomas that do not require immediate evacuation. BRAIN & SPINE 2023; 3:102672. [PMID: 38021007 PMCID: PMC10668091 DOI: 10.1016/j.bas.2023.102672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 12/01/2023]
Abstract
Introduction Embolization of the Middle Meningeal Artery (EMMA) is an emerging treatment option for patients with Chronic Subdural Haematoma (CSDH). Questions (1) Can EMMA change the natural history of untreated minimally symptomatic CSDH which do not require immediate evacuation? (2) What is the role of EMMA in the prevention of recurrence following surgical treatment? (3) Can the procedure be performed under local anaesthetic? Material and methods Systematic literature review. No randomised clinical trials available on EMMA for meta-analysis. Results Six unique large cohorts with more than 50 embolisations were identified (evidence: 3b-4). EMMA can control the progression of surgically naïve CSDH in 91.1-100% of the patients, in which haematoma expansion is halted, or the lesion decreases and resolves. Treatment failure requiring surgery occurs in 0-4.1% of the patients having EMMA as the primary and only treatment. Treatment failure requiring surgery goes up slightly to 6.8% if post-surgical patients are included. When EMMA is used as postsurgical adjunctive the risk of recurrence is 1.4-8.9% compared to 10-20% in surgical series. EMMA has minimal morbidity and it is feasible under local anaesthesia or slight sedation in the majority of cases. Conclusion There is cumulative low-quality evidence in the literature that EMMA may be able to modify the natural course of the disease. It appears effective in controlling progression of CSDHs in patients having it as a primary standing alone treatment and it reduces the risk of recurrence and the need for surgical intervention in refractory postsurgical cases or as a postsurgical adjunctive treatment with minimal morbidity (recommendation: C).
Collapse
Affiliation(s)
| | - Saffwan Mohamed
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - Oliver Kennion
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - Rajeev Padmanabhan
- Department of Neuroradiology, James Cook University Hospital, Middlesbrough, UK
| | - Aslam Siddiqui
- Department of Neuroradiology, James Cook University Hospital, Middlesbrough, UK
| | - Manjunath Prasad
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - Nitin Mukerji
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
4
|
Orscelik A, Senol YC, Bilgin C, Kobeissi H, Arul S, Cloft H, Lanzino G, Kallmes DF, Brinjikji W. Middle meningeal artery embolization without surgical evacuation for chronic subdural hematoma: a single-center experience of 209 cases. Front Neurol 2023; 14:1222131. [PMID: 37719752 PMCID: PMC10501738 DOI: 10.3389/fneur.2023.1222131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/03/2023] [Indexed: 09/19/2023] Open
Abstract
Background Middle meningeal artery (MMA) embolization is a minimally invasive treatment option for new and recurrent chronic subdural hematomas (cSDH). Objective To examine the safety and efficacy profile of MMA embolization without surgical evacuation for cSDH patients. Methods A single-center retrospective study of patients with cSDHs treated by MMA embolization was undertaken. Patient demographics, hematoma characteristics, procedural details, and clinical and radiological outcomes were collected. The primary outcome was the need for retreatment, and the secondary outcomes were at least a 50% reduction in the maximum width of cSDH on the last CT imaging, complications, and an improvement in the modified Rankin scale (mRS) score. All results were presented as descriptive statistics. Results A total of 209 MMA embolizations were successfully performed on 144 patients. Polyvinyl alcohol particles were the primary embolization agent in all procedures. Of the total of 206 cSDH, the median maximum width at pre-intervention and last follow-up were 12 and 3 mm, respectively, and the median reduction percentage was 77.5%, with a >50% improvement observed in 72.8% at the last follow-up imaging. A total of 13.8% of patients needed retreatment for recurrent, refractory, or symptomatic hematomas after embolization. The mRS score improved in 71 (49.3%) patients. Of 144 patients, 4 (2.8%) experienced complications related to the procedure, and 12 (8.4%) died during follow-up due to causes unrelated to the MMA embolization procedures. Conclusion This study supports the fact that MMA embolization without surgical evacuation is a safe and effective minimally invasive option for the treatment of cSDHs.
Collapse
Affiliation(s)
- Atakan Orscelik
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Yigit Can Senol
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Santhosh Arul
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Harry Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - David F. Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
5
|
Desir LL, Narayan V, Ellis J, Gordon D, Langer D, Ortiz R, Serulle Y. Middle Meningeal Artery Embolization in the Management of Chronic Subdural Hematoma: a Comprehensive Review of Current Literature. Curr Neurol Neurosci Rep 2023; 23:109-119. [PMID: 37037979 DOI: 10.1007/s11910-023-01262-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE OF REVIEW Chronic subdural hematoma (cSDH) is a common intracranial hemorrhagic disorder with a high incidence rate among the elderly. While small, asymptomatic cSDH may resolve spontaneously, surgical intervention has been the treatment of choice for larger, symptomatic cases. Surgical evacuation of cSDH may be associated with high rates of recurrence, and even asymptomatic cSDH cases tend to progress. Over the last few years, middle meningeal artery (MMA) embolization has proven to be a safe non-invasive treatment of choice with favorable outcomes and a low recurrence rate. The ensuing paper discusses current treatment modalities for cSDH and reviews existing literature on the anatomy of MMA and its embolization as a treatment option for cSDH. RECENT FINDINGS Recent studies show that traumatic head injury leading to subdural hemorrhage can induce neovascularization that may initiate a cycle of recurrent subdural hematoma. Distal branches of MMA supply blood to the dural layers. Several studies have revealed that embolization of the MMA can stop the neovascularization process and blood flow. In addition, patients who underwent MMA embolization had a significantly quicker brain re-expansion and lower recurrence rate. Although the management of cSDH is still very much a dilemma, recent research findings bring MMA embolization to light as a promising treatment alternative and adjunctive therapy.
Collapse
Affiliation(s)
- Likowsky L Desir
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
- City University of New York School of Medicine, New York, NY, USA
| | - Vinayak Narayan
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
| | - Jason Ellis
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
| | - David Gordon
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
| | - David Langer
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
| | - Rafael Ortiz
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA
| | - Yafell Serulle
- Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA.
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Neuroendovascular Surgery, Phelps Hospital, Sleepy Hollow, NY, USA.
| |
Collapse
|
6
|
Mohamed S, Villabona A, Kennion O, Padmananbhan R, Siddiqui A, Khan S, Prasad M, Mukerji N. Middle meningeal artery embolisation for chronic subdural haematomas: the first prospective UK study. Br J Neurosurg 2022; 36:786-791. [PMID: 35892289 DOI: 10.1080/02688697.2022.2097200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background/Objectives: MMA embolisation has emerged in recent years as a safe endovascular treatment for chronic subdural haematoma. We report the first UK series of endovascular treatment of chronic subdural haematomas.Design: Prospective case series.Subjects: All adult patients referred with midline shift ≤10 mm and GCS ≥13 were considered. Patients had to be mobile with a standard origin of Middle Meningeal and Ophthalmic arteries. Patients with GCS < 13 or profound weakness (MRC grade ≤ 3) were treated with burr hole drainage and placement of subdural drains.Methods: Patients were recruited over a 14-month period from 25 October 2020 to 25 December 21 through our electronic referral system. Patients' demographics, pre-morbid modified Rankin Score (mRS), symptoms; anticoagulation and co-morbidities were prospectively collected. Suitability for endovascular treatment was discussed with the interventional neuroradiologist and neurosurgeon. SQUID-12 embolic material was used for all MMA embolisations, which was performed under general anaesthetic. Baseline CT/MRI characteristics were collected. Further imaging was obtained at 7, 21, 90 and 180 days. Clinical assessment and mRS was completed at three months.Results: Fifteen patients underwent endovascular embolisation of MMA in the study period. Of these 13 were male, median age was 79 years. Median length of stay was four days. Follow-up CT at three months has demonstrated significant reduction in both midline shift (p = 0.002) and maximum thickness of haematoma (p = 0.001). Nine patients had reached the three months' follow-up period. All of them had complete or near-complete resolution of the CSDH. One patient required surgical rescue at two months post procedure due to progression of CSDH. We report one mortality due to COVID-19.Conclusions: For select patients, MMA embolisation is a safe alternative treatment option for chronic subdural haematoma. As we gain more experience, the procedure could be performed under local anaesthetic.
Collapse
Affiliation(s)
- Saffwan Mohamed
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - Alvaro Villabona
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - Oliver Kennion
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - Rajeev Padmananbhan
- Department of Neuroradiology, James Cook University Hospital, Middlesbrough, UK
| | - Aslam Siddiqui
- Department of Neuroradiology, James Cook University Hospital, Middlesbrough, UK
| | - Shahid Khan
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - Manjunath Prasad
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| | - Nitin Mukerji
- Department of Neurosurgery, James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
7
|
Reith W, Garner M. [Middle meningeal artery embolization for chronic subdural hematomas]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:641-647. [PMID: 35789427 DOI: 10.1007/s00117-022-01038-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 01/22/2023]
Abstract
The treatment of chronic subdural hematoma (cSDH) represents a challenge due to high recurrence rates (2-37%). One possible treatment option is middle meningeal artery (MMA) embolization as an alternative to surgery. In contrast to acute SDH, which is caused by a rupture of the bridging veins, cSDH has a different pathomechanism. Injury to the so-called dural boundary cell layer results in an intermittent or continuous cycle of cell proliferation, angiogenesis, secretion, and bleeding due to rupture of newly formed vessels within the SDH membrane. This membrane is supplied by the MMA. Embolization of the MMA leads to resorption of the cSDH. The results published so far regarding MMA embolization as sole therapy or in combination with surgical treatment are encouraging with a long-term success rate of up to 90%.
Collapse
Affiliation(s)
- Wolfgang Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Str., 66424, Homburg-Saar, Deutschland.
| | - Malvina Garner
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Str., 66424, Homburg-Saar, Deutschland
| |
Collapse
|
8
|
Abdelsalam A, Silva MA, Luther EM, Lu VM, Thompson JW, Burks JD, Saini V, Starke RM. Commentary: Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With D5W Push Technique. Neurosurgery 2022; 91:e63-e64. [PMID: 35834326 PMCID: PMC9514732 DOI: 10.1227/neu.0000000000002051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ahmed Abdelsalam
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Al-Salihi MM, Rahman MM, Al-Jebur MS, Rahman S. Letter: Middle Meningeal Artery Embolization Versus Conventional Treatment of Chronic Subdural Hematomas. Neurosurgery 2022; 90:e106-e107. [PMID: 35086981 DOI: 10.1227/neu.0000000000001858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Md Moshiur Rahman
- Department of Neurosurgery, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
| | | | - Sabrina Rahman
- Department of Public Health, Independent University-Bangladesh, Dhaka, Bangladesh
| |
Collapse
|
10
|
Shapiro M, Walker M, Carroll KT, Levitt MR, Raz E, Nossek E, Delavari N, Mir O, Nelson PK. Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization. J Neurointerv Surg 2021; 13:471-477. [PMID: 33632880 DOI: 10.1136/neurintsurg-2020-016798] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 02/03/2023]
Abstract
Adoption of middle meningeal artery embolization in the management of chronic subdural hematomas has led to a renewed interest in dural vascular anatomy. The readily identifiable major dural arteries and potential hazards associated with their embolization are well described. Less emphasized are several levels of intrinsic dural angioarchitecture, despite their more direct relationship to dural based diseases, such as subdural hematoma and dural fistula. Fortunately, microvascular aspects of dural anatomy, previously limited to ex vivo investigations, are becoming increasingly accessible to in vivo visualization, setting the stage for synthesis of the old and the new, and providing a rationale for the endovascular approach to subdural collections in particular. In contrast with traditional anatomical didactics, where descriptions advance from larger trunks to smaller pedicles, we present a strategic approach that proceeds from a fundamental understanding of the dural microvasculature and its relationship to larger vessels.
Collapse
Affiliation(s)
- Maksim Shapiro
- Radiology, Neurology, New York University School of Medicine, New York, New York, USA
| | - Melanie Walker
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kate T Carroll
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael R Levitt
- Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eytan Raz
- Radiology, NYU School of Medicine, New York, New York, USA
| | - Erez Nossek
- Neurosurgery, NYU School of Medicine, New York, New York, USA
| | - Nader Delavari
- Neurosurgery, NYU School of Medicine, New York, New York, USA
| | - Osman Mir
- Radiology, NYU School of Medicine, New York, New York, USA
| | - Peter Kim Nelson
- Radiology, Neurosurgery, NYU School of Medicine, New York, New York, USA
| |
Collapse
|
11
|
Moshayedi P, Liebeskind DS. Middle Meningeal Artery Embolization in Chronic Subdural Hematoma: Implications of Pathophysiology in Trial Design. Front Neurol 2020; 11:923. [PMID: 32973670 PMCID: PMC7481478 DOI: 10.3389/fneur.2020.00923] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/17/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Chronic subdural hematoma (cSDH) is a debilitating condition with a high rate of recurrence after surgical evacuation. Summary: This review is focused on middle meningeal artery (MMA) embolization to treat cSDH. We discuss the underlying pathophysiology of chronic subdural hematoma and how cessation of arterial flow may resolve a venous hemorrhage. We also present the current evidence for MMA embolization and the roadmap for future trials. Conclusion: Frequent multimodal imaging and cSDH sampling would enable us to understand mechanisms of MMA embolization in cSDH treatment and therefore improve our ability to offer MMA embolization to the eligible population.
Collapse
Affiliation(s)
- Pouria Moshayedi
- Department of Neurology, UCLA Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - David S Liebeskind
- Department of Neurology, UCLA Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|