Outcomes of middle meningeal artery embolization for treating chronic subdural hematoma

Published: 3 July 2024
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The study evaluates chronic subdural hematoma (cSDH) middle meningeal artery (MMA) embolization efficacy and safety. A prospective interventional study was conducted in Viet Duc Hospital from November 2021 to April 2024. All consecutive cSDH MMA embolization patients were included. Clinical and imaging data were collected before and one month after treatment. The study included 31 42-cSDH patients. Of these, 25.8% had hematoma evacuation, 83.9% were treated with surgery and embolization, and 16.1% with embolization alone. 92.9% of procedures used polyvinyl alcohol particles. The success rate was 92.9% and complications 7.1%. Asymptomatic external carotid artery vasospasm and MMA rupture occurred. Functional improvement occurred in 91.7% of patients one month after treatment. Significantly lower mean modified Rankin Scale (mRS) score (0.2±0.7 vs. 1.7±0.9; P=0.000) and higher proportion of patients with ≤2 mRS score (95.8% vs. 74.1%) were observed after treatment. Hematoma thickness decreased significantly (P=0.00) from 21.5±7.9 mm to 8.3±4.1 mm. The midline shift decreased significantly from 7.4±5.0 mm to 0.7±1.2 mm (P=0.00). Just one patient (4.2%) needed surgery. MMA embolization alone or with surgery appears to treat cSDH safely and effectively.

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Yang W, Huang J. Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am 2017;28:205-10.
Blaauw J, Jacobs B, Hertog HM den, et al. Mortality after chronic subdural hematoma is associated with frailty. Acta Neurochir 2022;164:3133-41. DOI: https://doi.org/10.1007/s00701-022-05373-w
Edlmann E, Giorgi-Coll S, Whitfield PC, et al. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation 2017;14:108. DOI: https://doi.org/10.1186/s12974-017-0881-y
Ivamoto HS, Lemos HP, Atallah AN. Surgical treatments for chronic subdural hematomas: a comprehensive systematic review. World Neurosurg 2016;86:399-418. DOI: https://doi.org/10.1016/j.wneu.2015.10.025
Fiorella D, Arthur AS. Middle meningeal artery embolization for the management of chronic subdural hematoma. J Neurointerv Surg 2019;11:912-5. DOI: https://doi.org/10.1136/neurintsurg-2019-014730
Yang W, Huang J. Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am 2017;28:205-10. DOI: https://doi.org/10.1016/j.nec.2016.11.002
Hashimoto T, Ohashi T, Watanabe D, et al. Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas. Surg Neurol Int 2013;4:104. DOI: https://doi.org/10.4103/2152-7806.116679
Pouvelle A, Pouliquen G, Premat K, et al. Larger middle meningeal arteries on computed tomography angiography in patients with chronic subdural hematomas as compared with matched controls. J Neurotrauma 2020;37:2703-8. DOI: https://doi.org/10.1089/neu.2020.7168
Takizawa K, Sorimachi T, Ishizaka H, et al. Enlargement of the middle meningeal artery on MR angiography in chronic subdural hematoma. J Neurosurg 2016;124:1679-83. DOI: https://doi.org/10.3171/2015.5.JNS1567
Salem MM, Kuybu O, Nguyen Hoang A, et al. Middle meningeal artery embolization for chronic subdural hematoma: predictors of clinical and radiographic failure from 636 embolizations. Radiology 2023;307:e222045. DOI: https://doi.org/10.1148/radiol.222045
Krothapalli N, Patel S, Fayad M, et al. Outcomes of particle versus liquid embolic materials used in middle meningeal artery embolization for the treatment of chronic subdural hematoma. World Neurosurg 2023;173:e27-e36. DOI: https://doi.org/10.1016/j.wneu.2023.01.077
Shehabeldin M, Amllay A, Jabre R, et al. Onyx Versus particles for middle meningeal artery embolization in chronic subdural hematoma. Neurosurgery 2023;92:979-85. DOI: https://doi.org/10.1227/neu.0000000000002307
Kan P, Maragkos GA, Srivatsan A, et al. Middle Meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations. neurosurgery. 2021;88:268-77. DOI: https://doi.org/10.1093/neuros/nyaa432
Gomez-Paz S, Akamatsu Y, Salem MM, et al. Upfront middle meningeal artery embolization for treatment of chronic subdural hematomas in patients with or without midline shift. Interv Neuroradiol 2021;27:571-6. DOI: https://doi.org/10.1177/1591019920982816
Tempaku A, Yamauchi S, Ikeda H, et al. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature. Interv Neuroradiol 2015;21:366. DOI: https://doi.org/10.1177/1591019915583224
Link TW, Schwarz JT, Paine SM, et al. Middle Meningeal Artery Embolization for Recurrent Chronic Subdural Hematoma: A Case Series. World Neurosurg 2018;118:e570-e574. DOI: https://doi.org/10.1016/j.wneu.2018.06.241
Shotar E, Meyblum L, Premat K, et al. Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma. J Neurointerv Surg 2020;12:1209-13. DOI: https://doi.org/10.1136/neurintsurg-2020-016048
Lam A, Selvarajah D, Htike SS, et al. The efficacy of postoperative middle meningeal artery embolization on chronic subdural hematoma - A multicentered randomized controlled trial. Surg Neurol Int 2023;14:168. DOI: https://doi.org/10.25259/SNI_208_2023
Ng S, Derraz I, Boetto J, et al. Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption. J Neuro Interv Surg 2020;12:695-99. DOI: https://doi.org/10.1136/neurintsurg-2019-015421
Srivatsan A, Mohanty A, Nascimento FA, et al. Middle meningeal artery embolization for chronic subdural hematoma: meta-analysis and systematic review. World Neurosurg 2019;122:613-9. DOI: https://doi.org/10.1016/j.wneu.2018.11.167
Waqas M, Vakhari K, Weimer PV, et al. Safety and effectiveness of embolization for chronic subdural hematoma:
systematic review and case series. World Neurosurg 2019;126:228-36. DOI: https://doi.org/10.1016/j.wneu.2019.02.208
Court J, Touchette CJ, Iorio-Morin C, et al. Embolization of the Middle meningeal artery in chronic subdural hematoma - A systematic review. Clin Neurol Neurosurg 2019;186:105464. DOI: https://doi.org/10.1016/j.clineuro.2019.105464
Di Cristofori A, Remida P, Patassini M, et al. Middle meningeal artery embolization for chronic subdural hematomas. A systematic review of the literature focused on indications, technical aspects, and future possible perspectives. Surg Neurol Int 2022;13:94. DOI: https://doi.org/10.25259/SNI_911_2021
Ironside N, Nguyen C, Do Q, et al. Middle meningeal artery embolization for chronic subdural hematoma: a systematic review and meta-analysis. J Neurointerv Surg 2021;13:951-7. DOI: https://doi.org/10.1136/neurintsurg-2021-017352
Joyce E, Bounajem MT, Scoville J, et al. Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases. Neurosurg Focus 2020;49:E5. DOI: https://doi.org/10.3171/2020.7.FOCUS20518
Cannarsa GJ, Olexa J, Chryssikos T, et al. Stand-alone middle meningeal artery embolization for treatment of giant chronic subdural hematoma in elderly frail patients: a case series. Neurosurgery 2021;89:S6. DOI: https://doi.org/10.1093/neuros/okaa025_S169
Jumah F, Osama M, Islim AI, et al. Efficacy and safety of middle meningeal artery embolization in the management of refractory or chronic subdural hematomas: a systematic review and meta-analysis. Acta Neurochir (Wien) 2020;162:499-507. DOI: https://doi.org/10.1007/s00701-019-04161-3

How to Cite

Hai, D. X., Thong, P. M., He, D.-V., Dung, L. T., Hung, D. D., Huyen, N.-T., & Minh Duc, N. (2024). Outcomes of middle meningeal artery embolization for treating chronic subdural hematoma. Italian Journal of Medicine, 18(3). https://doi.org/10.4081/itjm.2024.1759