Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis

Authors

Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Andrew F. Ducruet, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Candice L. Nguyen, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Jacob F. Baranoski, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Tyler S. Cole, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Neil Majmundar, Barrow Neurological Institute, Phoenix, Arizona, USA.
D Andrew Wilkinson, Barrow Neurological Institute, Phoenix, Arizona, USA.
Vance L. Fredrickson, Department of Neurosurgery, University of Southern California, Los Angeles, California, USA.
Daniel D. Cavalcanti, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Felipe C. Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA Felipe.Albuquerque@barrowbrainandspine.com.Follow

Document Type

Article

Abstract

BACKGROUND: Recently, middle meningeal artery (MMA) embolization has emerged as a potentially safe and effective method of treating chronic subdural hematoma (cSDH). OBJECTIVE: To report a single-center experience with MMA embolization and examines the type of embolic material used, the extent of penetration, and the number of MMA branches embolized. METHODS: A retrospective analysis of all patients with MMA embolization from 2018 through 2019 was performed. A failed outcome was defined as either surgical rescue and/or greater than 10 mm of hematoma residual or reaccumulation following embolization. RESULTS: Of 35 patients, surgery had failed for 9 (26%) and initial conservative treatment had failed for 6 (17%). Of 41 MMA embolizations, including those in six patients with bilateral cSDH who underwent bilateral MMA embolization, 29 (72%) were performed using ethylene vinyl alcohol copolymer (Onyx), 7 (17%) using particles, and 5 (12%) using n-butyl cyanoacrylate. Both the anterior and posterior MMA divisions were embolized in 29 cases (71%); distal penetration of these branches was achieved in 25 embolizations (61%). Twenty-six (63%) cSDHs completely resolved. Complete resolution was seen in 22 of 29 hematomas (76%) in which both anterior and posterior MMA branches were occluded versus 4 of 12 (33%) following single-branch embolization (p=0.014). Embolization of one cSDH (2%) failed. CONCLUSION: MMA embolization of cSDHs appears to be both safe and efficacious. Furthermore, embolization of both the anterior and posterior MMA branches may be associated with increased odds of complete resolution.

Keywords

angiography, embolic, subdural

Medical Subject Headings

Aged; Aged, 80 and over; Embolization, Therapeutic (methods); Enbucrilate (administration & dosage); Female; Hematoma, Subdural, Chronic (diagnostic imaging, surgery, therapy); Humans; Male; Meningeal Arteries (diagnostic imaging, surgery); Middle Aged; Polyvinyls (administration & dosage); Retrospective Studies

Publication Date

7-1-2021

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

Volume

13

Issue

7

First Page

657

Last Page

660

PubMed ID

33077579

Digital Object Identifier (DOI)

10.1136/neurintsurg-2020-016552

Recommended Citation

Catapano, Joshua S.; Ducruet, Andrew F.; Nguyen, Candice L.; Baranoski, Jacob F.; Cole, Tyler S.; Majmundar, Neil; Wilkinson, D Andrew; Fredrickson, Vance L.; Cavalcanti, Daniel D.; and Albuquerque, Felipe C., "Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis" (2021). Translational Neuroscience. 2131.
https://scholar.barrowneuro.org/neurobiology/2131