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Alofi AD, Alsharif TH, Alshamrani AA, Alsulami AA, Alamri Z, Alsuwat MA. The Use of Middle Meningeal Artery Embolization to Treat Chronic Subdural Hematoma in the Pediatric Population: A Review of the Literature. Cureus 2024; 16:e61874. [PMID: 38978883 PMCID: PMC11228415 DOI: 10.7759/cureus.61874] [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] [Accepted: 06/07/2024] [Indexed: 07/10/2024] Open
Abstract
Chronic subdural hematoma (cSDH) is rare in the pediatric population and typically arises from various causes. These include trauma (accidental, non-accidental, or birth-related injuries), coagulopathies (such as hemophilia or von Willebrand disease), vascular malformations (such as arteriovenous malformations), and complications from previous surgeries. These diverse etiologies contribute to the complexity of managing this condition. Although middle meningeal artery (MMA) embolization is proven effective in adults, limited studies have investigated its applicability in pediatrics. This study aims to assess the efficacy, safety, and outcomes of MMA embolization in the pediatric age group, guiding future research and treatment strategies. A systematic review of the literature was conducted using PubMed, Web of Science, and Embase. No restrictions were applied regarding publication status or follow-up duration. The inclusion criteria were studies that integrated MMA embolization as a treatment for cSDH in pediatric patients. Data extracted included patient sample and characteristics, cSDH etiology and characteristics, prior intervention, procedural technique and indication, and clinical and radiological outcomes. Twelve studies were included in the review, comprising a total of 14 patients. There were no randomized clinical trials or large-scale cohort studies. The included literature consisted of 11 case reports and one case series, and the results described a clinical and radiological outcome in a varied mix of patients with different characteristics and backgrounds for cSDH. No neurological complications attributed to MMA embolization were reported. Follow-up showed resolved or decreased size of cSDH in all patients except for one, who experienced hematoma expansion despite treatment. MMA embolization may be considered a primary or adjuvant treatment modality for cSDH in the pediatric population. However, further research is needed to investigate the impact of different etiologies on outcomes and to highlight long-term complications and results.
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Affiliation(s)
| | | | | | | | - Zeyad Alamri
- Neurosurgery, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
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Siahaan AMP, Indharty S, Tandean S, Tommy T, Loe ML, Nainggolan BWM, Pangestu D, Susanto M. Middle meningeal artery embolization and pediatric chronic subdural hematoma: a systematic review of the literature. Neurosurg Rev 2023; 46:239. [PMID: 37697174 DOI: 10.1007/s10143-023-02130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
Chronic subdural hematoma (CSDH) is a disease commonly found in the elderly and not a typical finding in pediatric population. History of shunt surgery, child abuse, and blood disorder are some of the common causes of pediatric CSDH (pCSDH). There is growing evidence about the role of middle meningeal artery embolization (MMAE) to manage CSDH in the elderly population with a high risk of rebleeding. However, the evidence in the pediatric population is still sparse. A systematic literature search was conducted on PubMed, Scopus, and Web of Science database from January, 2023, to March, 2023. Search strings were generated based on the combination of modified search terms, such as CSDH, MMA embolization, and child. Risk of bias was assessed using the Cochrane Risk of Bias in Nonrandomized Study for Intervention. Nine articles were included in this review. The success rate of MMA embolization in pediatric CSDH was 88.8%. Histories of ventriculoperitoneal shunt, blood coagulation disorder, and trauma were the causes of CSDH. Time to achieve success was varied from 2 to 9 months. No study with low risk of bias was found. This systematic review found no high-quality evidence regarding the role of MMA embolization in the management of pCSDH. However, due to its high success rate, MMAE could be a promising approach to treat pCSDH.
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Affiliation(s)
| | - Suzy Indharty
- Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Steven Tandean
- Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Thomas Tommy
- Department of Neurosurgery, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | | | | | - Dimas Pangestu
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Martin Susanto
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Nakagawa I, Kotsugi M, Yokoyama S, Maeoka R, Tamura K, Takeshima Y, Matsuda R, Yamada S, Nishimura F, Park YS, Nakase H. Extensive Roles and Technical Advances of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma. Neurol Med Chir (Tokyo) 2023; 63:327-333. [PMID: 37286481 PMCID: PMC10482489 DOI: 10.2176/jns-nmc.2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/03/2023] [Indexed: 06/09/2023] Open
Abstract
Chronic subdural hematoma (CSDH) is a common pathology that typically affects the elderly in Japan, an aging society. Burr-hole irrigation is the standard treatment, but middle meningeal artery (MMA) embolization is a minimally invasive alternative. MMA embolization for CSDH has frequently been reported in recent years, and many technical innovations to improve clinical outcomes have been described. Embolic materials reaching more distally are found to avoid recurrences after MMA embolization. As a result, various studies have described the superiority of embolizing the anterior and posterior branches of the MMA, the advantages of embolic materials reaching beyond the midline, and a high degree of distal penetration using a "sugar rush technique" in which 5% soluble glucose is injected through an intermediate catheter during MMA embolization. Radiographically, reports have described the importance of a "bright falx" sign obtained by infiltrating embolic material beyond the midline and post-embolization enhancement of the dura, capsular membrane, septations, and subdural hematoma fluid as indicators of the spread of embolic materials. This review provides an overview of the current status and future challenges in MMA embolization for CSDH, focusing on technical aspects to improve clinical outcomes.
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Hersh DS, Martin JE, Bulsara KR, Ollenschleger MD. In Reply: Middle Meningeal Artery Embolization for Primary Treatment of a Chronic Subdural Hematoma in a Pediatric Patient: A Systematic Review of the Literature and Case Report. Oper Neurosurg (Hagerstown) 2023; 24:e387-e388. [PMID: 36804346 DOI: 10.1227/ons.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA.,Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - Jonathan E Martin
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA.,Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - Ketan R Bulsara
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.,Division of Neurosurgery, UConn School of Medicine, Farmington, Connecticut, USA
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Paro MR, Ollenschleger MD, Fayad MF, Bulsara KR, Stoltz P, Martin JE, Bookland MJ, Hersh DS. Middle Meningeal Artery Embolization for Primary Treatment of a Chronic Subdural Hematoma in a Pediatric Patient: A Systematic Review of the Literature and Case Report. Oper Neurosurg (Hagerstown) 2023; 24:3-10. [PMID: 36519875 DOI: 10.1227/ons.0000000000000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Middle meningeal artery (MMA) embolization is becoming increasingly studied as a safe, effective treatment for chronic subdural hematoma (cSDH) in adults. Among pediatric patients, however, MMA embolization for cSDH has been rarely described, and the potential benefit of this approach for pediatric patients remains unknown. OBJECTIVE To systematically review the literature and identify cases of pediatric MMA embolization for cSDH. We also report our experience with pediatric MMA embolization. METHODS A systematic review of the literature was performed to identify cases of pediatric MMA embolization for cSDH. Inclusion criteria included English language availability and pediatric age defined as less than 18 years. A pediatric patient treated with MMA embolization was also identified at our institution. RESULTS Five cases of pediatric MMA embolization for cSDH were identified in the literature. Two were associated with arachnoid cysts, 2 with antiplatelet/anticoagulation therapy, and 1 with abusive head trauma. There were no adverse events, and all patients demonstrated clinical and radiological improvement on follow-up. At our institution, a previously healthy 8-year-old male was found to have a right-sided acute-on-chronic SDH during a headache evaluation. A diagnostic angiogram was performed to rule out a dural arteriovenous fistula, and right-sided MMA embolization was performed concurrently. Rapid clinical and radiological improvement was observed, with complete resolution by 6 months. CONCLUSION MMA embolization may represent a treatment option for pediatric patients with cSDH.
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Affiliation(s)
- Mitch R Paro
- UConn School of Medicine, Farmington, Connecticut, USA
| | | | - Mohamad F Fayad
- Hartford Hospital, Department of Radiology, Hartford, Connecticut, USA
| | - Ketan R Bulsara
- UConn School of Medicine, Farmington, Connecticut, USA.,Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.,Division of Neurosurgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - Petronella Stoltz
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | - Jonathan E Martin
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.,Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | - Markus J Bookland
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.,Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
| | - David S Hersh
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA.,Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA
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Souter J, Behbahani M, Sharma S, Cantrell D, Alden TD. Middle meningeal artery embolization in pediatric patient. Childs Nerv Syst 2022; 38:1861-1866. [PMID: 35962222 DOI: 10.1007/s00381-022-05639-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE There is paucity of data in management of recurrent and expanding subdural hematomas (SDH) within the pediatric population, who are otherwise not surgical candidates. Middle meningeal artery (MMA) embolization has been utilized minimally in this population and here, we explore the utility of this procedure in a 15-month-old-child, along with review of the literature. METHODS A case report of a 15-month-old child who underwent MMA embolization for recurrent and expanding SDH in the setting of anticoagulation for cardiac condition. A literature review of MMA embolization in pediatric patients was conducted. RESULTS Initially stabilization of SDH was noted on serial imaging; however, recurrent hemorrhages were noted with subsequent boluses of antiplatelet and anticoagulating agents. There are only 5 total reported cases, included ours, of MMA embolization in pediatrics with an overall success rate of 80%. CONCLUSION Treatment of chronic or recurrent subdural hematoma by MMA embolization in the pediatric population is understudied. Our case notes limitation of this procedure and impact on long-term success, specifically in patients with systemic illness and ongoing anticoagulation.
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Affiliation(s)
- John Souter
- Department of Neurological Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Mandana Behbahani
- Division of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Shelly Sharma
- Division of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Donald Cantrell
- Division of Interventional Radiology, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Tord D Alden
- Division of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, USA.
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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