Middle meningeal artery embolization for chronic subdural hematoma in elderly patients at high risk of surgical treatment

• Published in: Journal of cerebrovascular and endovascular neurosurgery Vol. 25; no. 1; pp. 28 - 35
• Main Authors: Seok, Jin Hoo, Kim, Jong Hyun, Kwon, Taek Hyun, Byun, Joonho, Yoon, Won Ki
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Cerebrovascular Surgeons and Korean NeuroEndovascular Society 01-03-2023
• Subjects: Clinical; Craniotomy; Embolization; Chronic subdural hematoma; Middle meningeal artery
• ISSN: 2234-8565; 2287-3139
• DOI: 10.7461/jcen.2022.e2022.08.003

The purpose of this study was to evaluate the effectiveness of middle meningeal artery embolization (MMAE) in elderly high-risk patients with symptomatic chronic subdural hematoma (CSDH) in terms of reduction in hematoma volume and recurrence rate.
We retrospectively reviewed data prospectively collected from nine patients who underwent 13 MMAE for CSDH between June 2017 and May 2022. The volume of the subdural hematoma was measured using a computer-aided volumetric analysis program. Hematoma volume changes during the follow-up period were analyzed and clinical outcomes were evaluated.
The mean follow-up period was 160 days (range, 46-311 days). All procedures were technically successful and there were no procedure-related complications. Of the 13 MMAE, 84% (11 out of 13 hemispheres) showed mean 88% of reduction on follow-up volumetric study with eight cases of complete resolution. There was one refractory case with MMAE which had been performed multiple burr-hole trephinations, for which treatment was completed by craniotomy and meticulous resection of multiple pseudomembranes. There was no recurrent case during the follow-up period, except for refractory case.
MMAE for CSDH in selected high-risk elderly patients and relapsed patients might be effective. Despite the small cohort, our findings showed a high rate of complete resolution with no complications. Further prospective randomized trials are warranted to evaluate its usefulness as a primary treatment option for CSDH.