J Cerebrovasc Endovasc Neurosurg.  2023 Jun;25(2):214-223. 10.7461/jcen.2023.E2022.08.001.

Helical coils augment embolization of the middle meningeal artery for treatment of chronic subdural hematoma: A technical note

• Wali AR
• Himstead A
• Bravo J
• Brandel MG
• Hirshman BR
• Pannell JS
• Nguyen AD
• Santiago-Dieppa DR

• KMID: 2543519
• DOI: http://doi.org/10.7461/jcen.2023.E2022.08.001

Abstract

Embolization of the middle meningeal artery (MMA) is a safe and effective adjunct in the treatment of chronic subdural hematoma. While prior authors describe the use of coils to assist embolization by preventing reflux through eloquent collaterals, we de- scribe the use of coils to further open the MMA, allowing the administration of greater amounts of embolisate for a more robust embolization. The objective of this study was to demonstrate that helical coils can safely open the MMA following the administration of polyvinyl alcohol (PVA) particles. This allows for more embolisate to be administered into the MMA for more effective treatment. A retrospective review was conducted at our institution including intraoperative images and postoperative clinical and radiographic follow up. Failure rates using MMA embolization with PVA and helical coil augmentation were compared to failure rates in the literature of MMA embolization with PVA or ethylene vinyl-alcohol copolymer alone. A total of 8 cases were reviewed in which this technique was implemented. There were no immediate complications after treatment. All patients that underwent helical coil embolization following the administration of PVA had increased amount of embolisate delivered into the MMA. All patients at follow up had resolution of the subdural hematoma on outpatient imaging. Helical coil embolization allows for more embolisate administration into the MMA and provides a technical advantage for patients that fail traditional techniques of embolization. Case series are taking place to further test this hypothesis and identify the ideal patient population that may gain maximal yield from this novel technique.

Keyword

Chronic subdural hematoma; Middle meningeal artery embolization; Helical coil; Augmentation; Recurrence

Figure

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  Fig. 1. Graphic representation of helical coil technique for MMA embolization. PVA, polyvinyl alcohol; MMA, middle meningeal artery

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  Fig. 2. Sequential embolization of right middle meningeal artery (MMA). Superselective angiography of the intact right MMA, lateral view (A). Demonstration of flow stasis in right MMA after initial embolisate deployment (B). Restoration of flow through right MMA after deployment of helical coils (C). Further and complete embolization of right MMA after helical coil deployment (D).

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  Fig. 3. Chronic subdural hematoma (cSDH) progression. Axial CT showing bilateral cSDH (arrows) prior to MMA embolization (A). Axial CT scan at 4 months follow-up showing comlete resolution of bilateral cSDH after MMA embolization (B). CT, computed tomography; MMA, middle meningeal artery

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