Middle meningeal artery embolization for chronic subdural hematoma with high risk of recurrence: A single institution experience

•There is no definite surgical procedure for patients suffer recurrent or difficult-to-treat CSDH.•We experienced 18 cases of MMA embolization performed to treat CSDH with high risk of recurrence, and no recurrence or post-procedure complication was observed.•The result indicated that MMA embolizati...

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Published in:Clinical neurology and neurosurgery 2020-10, Vol.197, p.106097-106097, Article 106097
Main Authors: Yajima, Hirohisa, Kanaya, Hideaki, Ogino, Masahiro, Ueki, Keisuke, Kim, Phyo
Format: Article
Language:English
Subjects:
Anticoagulants
Asymptomatic
Atrophy
Blood
Brain
Catheters
Chronic subdural hematoma
Dura mater
Embolization
Hematoma
Medical imaging
Meninges
Middle meningeal artery
Neurology
Patients
Polyvinyl alcohol
Recurrence
Risk factors
Thrombocytopenia
Veins & arteries
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Summary:•There is no definite surgical procedure for patients suffer recurrent or difficult-to-treat CSDH.•We experienced 18 cases of MMA embolization performed to treat CSDH with high risk of recurrence, and no recurrence or post-procedure complication was observed.•The result indicated that MMA embolization was effective to prevent the recurrence of CSDH without increasing treatment-related complications. Middle meningeal artery (MMA) embolization can be a treatment option for selected cases of chronic subdural hematoma (CSDH) patients. However, appropriate timing of this procedure or the conditions to be considered are still not standardized. Between 2008 and 2018, 18 symptomatic CSDH patients underwent MMA embolization at our institution. The timing of embolization and the risk factors for recurrence of CSDH, the recurrence rate after an embolization, and the complication were thoroughly reviewed. Of the 18 cases, 16 patients were male. The median age at MMA embolization was 78.5 years (range, 66–98 years). The median follow-up period were eight months (range, 2–53 months). Possible risk factors for CSDH recurrence harbored by those patients were age > 74 yrs (10), brain atrophy (4), separated hematoma (3), coagulopathy (3), anticoagulant administration (3), and thrombocytopenia (1). No recurrence or complication was observed in any of the patients after the embolization. MMA embolization is effective and safe in preventing recurrence of CSDH with high risk of recurrence, and could be a standard treatment for such cases.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2020.106097