J Cerebrovasc Endovasc Neurosurg.  2023 Mar;25(1):28-35. 10.7461/jcen.2022.E2022.08.003.

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

• Seok JH
• Kim JH
• Kwon TH
• Byun J
• Yoon WK

• KMID: 2540805
• DOI: http://doi.org/10.7461/jcen.2022.E2022.08.003

Abstract

Objective
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.
Methods
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.
Results
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.
Conclusions
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.

Keyword

Chronic subdural hematoma; Embolization; Middle meningeal artery; Craniotomy

Figure

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  Fig. 1. The hematoma model was reconstructed using OsiriX software (an open-source DICOM viewer, OsiriX Lite, v.12.5.2 32bit, Pixmeo, Geneva, Switzerland). (A) Axial CT-scan showing a right-sided subdural hematoma (SDH). Volumetric measurements were performed by hand-tracing the hematoma form in each slice, as shown in green. (B) 3D frontal aspect reconstruction of computer-assisted volumetric measurement of single-sided SDH. (C) 3D medial aspect reconstruction of computer-assisted volumetric measurement of single-sided SDH. (D) 3D lateral aspect reconstruction of computer-assisted volumetric measurement of single-sided SDH. CT, computed tomography

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  Fig. 2. Pattern of volume reduction. This graph indicates changes in hematoma volume after performing MMAE in each patient who showed complete resorption. MMAE, middle meningeal artery embolization

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