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. 2023 May 30;15(5):e39733.
doi: 10.7759/cureus.39733. eCollection 2023 May.

Revolutionizing Treatment for Chronic Subdural Hematoma: Promising Outcomes With Middle Meningeal Artery Embolization

Ali Msheik  1 , Teddy Gerges  2 , Zeinab Al Mokdad  3 , Daniel Abbass  4 , Assaad Mohanna  5 , Ahmad Aoude  6
Affiliations

Revolutionizing Treatment for Chronic Subdural Hematoma: Promising Outcomes With Middle Meningeal Artery Embolization

Ali Msheik et al. Cureus. .

Abstract

Chronic subdural hematoma (cSDH) is a common condition that typically requires surgical intervention. Middle meningeal artery embolization (MMAE) has emerged as a potential alternative treatment option, although the choice of embolization material remains a topic of debate. In this case series, we report on the outcomes of 10 patients with cSDH who underwent MMAE. Most patients experienced symptom relief and a significant reduction in cSDH size post-procedure. Despite the presence of comorbidities and risk factors, most patients had positive outcomes following MMAE treatment. Only one patient required surgical intervention after the MMAE procedure due to the progression of symptoms, while MMAE successfully prevented recurrence in most patients. Our findings suggest that MMAE can be a promising treatment option for selected patients with cSDH. However, further studies are needed to compare the efficacy and safety of different embolization materials in MMAE procedures for cSDHs.

Keywords: brain trauma indicator; chronic subdural hematoma (csdh); mma embolization; neuro-surgery; new oral anticoagulants ( noacs).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Distribution of patients according to findings and procedures.
*Patient diagnosed with bilateral cSDHs after ventricular-peritoneal shunting due to cranial penetrating injury-provoked hydrocephalus. MMAE: Middle meningeal artery embolization; cSDH: Chronic subdural hematoma.
Figure 2
Figure 2. Sample digital subtraction angiographs (DSA) of four patients.
Right-sided images: Pre-MMAE; Left-sided images: Post-MMAE; p: patient; Black arrowhead: Anterior MMA; Yellow arrowhead: Posterior MMA; Red arrowhead: terminal Blush pre-MMAE; Grey arrowhead: terminal Blush post-MMAE; Black Star: MMA before embolization; Blue Star: MMA post embolization. Source: Al Rassoul Al-Aazam Radiology Department. Permission was obtained.
Figure 3
Figure 3. Evolution of a bilateral cSDH before and after MMAE.
A: Cranial MRI showing bilateral cSDHs at presentation; B: Cranial MRI three weeks Post-MMAE; C: Cranial CT scan six weeks post-MMAE. Blue arrows: large cSDH at presentation; Yellow arrows: diminished size cSDHS three weeks post-MMAE. cSDH: Chronic subdural hematomas; MMAE: Middle meningeal artery embolization.
Figure 4
Figure 4. Algorithm and middle meningeal artery embolization indication advised by the authors.
1Neurological deficit; cerebral midline shift evident on imaging. Blue dashed arrow: Management continues similarly. cSDH: Chronic subdural hematoma; MMAE: Middle meningeal artery embolization. Permission was obtained from the authors.
See this image and copyright information in PMC

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