No abstract

Background: This is a literature review aiming to provide an update about the recent findings related to the efficacy of middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematomas (cSDHs), comparison with conventional therapy and deduction of the current recommendations and indications. Methods: The literature is reviewed using a search through the PubMed index using keywords. Studies are then screened, skimmed, and thoroughly read. 32 studies fulfilled the inclusion criteria and are included in the study. Results: Five indications for the application of MMA embolization (MMAE) are deducted from the literature. The usage as a preventive measure after surgical treatment of symptomatic cSDHs in patients with a high risk of recurrence and the usage as a standalone procedure has been the most common reasons for indication of this procedure. Rates of failures for the aforementioned indications have been 6.8% and 3.8%, respectively. Conclusion: The safety of MMAE as a procedure is regarded as a general theme in the literature and can be considered for future applications. Usage of this procedure in clinical trials with more patient segregation and timeframe assessment relative to surgical intervention are recommendations of this literature review.

Background: Endovascular embolization is one of the main modalities in the treatment of brain arteriovenous malformations (AVMs). Onyx (ethylene-vinyl alcohol copolymer) is a new embolic agent with some advantages of slow injection and better control of penetration. Objectives: To report our experience in the embolization of brain AVMs with Onyx. Patients and Methods: From August 2012 to October 2014, 53 consecutive patients harboring brain AVM were treated with Onyx as the sole embolic agent during 85 procedures. There were 27 males and 26 females with a mean age of 27.2 years (range, 8 -65 years). Results: The presenting symptom was headache in 25 (47%), neurological deficit in 18 (35%), and seizure in ten (18%) patients. According to the Spetzler-Martin grading scale, three of the AVMs were ranked as grades I, 11 as grade II, 22 as grade III, 14 as grade IV, and three as grade V. An average of 1.8 feeding pedicles were embolized in each case, whereas a mean of 2.23-mL Onyx was used per patient. Initial complete obliteration at the end of all embolization procedures was achieved in 11 patients (20.08%). The rate of complete embolization at 6-month follow-up was 15%. After completion of embolization, the neurologic status was unchanged or improved in 46 (87%) patients. We observed treatment-related neurologic deficit in seven (13%) patients, of whom five were permanent (10%). There was no procedure-related death. Conclusion: Our experience with Onyx used for embolizing AVMs was satisfactory. Controlled injections that protect the draining veins make the therapy safe even in complex AVMs.

No abstract