J Korean Med Assoc.  2024 Jun;67(6):396-402. 10.5124/jkma.2024.67.6.396.

Endovascular surgery for chronic subdural hematoma

• Hwang G

• KMID: 2556023
• DOI: http://doi.org/10.5124/jkma.2024.67.6.396

Abstract

Background
Endovascular surgery is rapidly advancing and is widely used for the management of various cerebrovascular diseases. Usually, chronic subdural hematomas are treated surgically; however, endovascular surgery is recently being attempted as a new treatment option based on the pathophysiology of this condition.
Current Concepts
Chronic subdural hematomas have an outer membrane derived from the dura mater. Sinusoidal capillaries in the outer membrane are a source of bleeding, which leads to hematoma growth and postoperative recurrence. Theoretically, embolization of the middle meningeal artery using endovascular procedures can prevent bleeding from the outer membrane and promote spontaneous resolution of a hematoma. Clinical studies, including recent prospective trials, have demonstrated the superior efficacy and safety of middle meningeal artery embolization over conventional treatment.
Discussion and Conclusion
More clinical trials on endovascular surgery for chronic subdural hematomas are forthcoming. We expect that the results of future studies will strengthen the findings of recent prospective trials and contribute to a major shift in the management of chronic subdural hematomas.

Keyword

Chronic subdural hematoma; Endovascular procedures; Therapeutic embolization; Meningeal arteries; 만성 경막하혈종; 혈관내수술; 색전술; 수막동맥