Application of Absolute Alcohol in the Treatment of Traumatic Intracranial Hemorrhage via Interventional Embolization of Middle Meningeal Artery

Abstract

Background: Traumatic brain injury is a common condition in neurosurgery. Traditional methods of treatment include conservative treatment and surgical evacuation using burr-holes or craniotomy; however, studies have reported problems such as high re-expansion rates after conservative treatment of epidural hematoma and high postoperative recurrence rates of subdural hematoma. Solutions to these problems are lacking, and research into new treatment methods is ongoing. Among the potential new treatments, middle meningeal arterial embolization is an option. This study involved patients with acute epidural hematoma and chronic subdural hematoma. The purpose was to evaluate the use and effects of absolute alcohol to embolize the middle meningeal artery to treat intracranial hematoma. Material and Methods: A retrospective description study was 12 cases of intracranial hematoma who treated with absolute alcohol interventional therapy from our hospital between June 2018 and October 2019. Five patients with acute epidural hematoma and seven patients with chronic subdural hematoma were treated using absolute alcohol to embolize the middle meningeal artery. Patients' clinical data, imaging results, surgical results, and prognosis were recorded and analyzed. Results: All patients underwent absolute alcohol embolization of the middle meningeal artery, in combination with burr-hole drainage. All imaging data were confirmed preoperatively. We successfully used absolute alcohol to embolize the middle meningeal artery intraoperatively and confirmed these results by postoperative angiography. All patients achieved symptomatic relief without complications, and no recurrence or re-expansion was seen with follow-up computed tomography. Our study has been registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , ChiCTR1800018714). Conclusion: The use of absolute alcohol to embolize the middle meningeal artery could be used as an attempt to treat acute epidural hematoma and chronic subdural hematoma.

Middle Meningeal Artery Embolization for the Treatment of Bilateral Chronic Subdural Hematoma

“…Link et al ( 6) introduced a novel approach to MMA embolization, which provides a minimally invasive and low-risk initial treatment alternative to surgery for patients with symptomatic CSDH when clinically appropriate. In our previous study (41), we reported on the use of absolute alcohol as an embolic agent to prevent the re-expansion and relapse of acute epidural hematoma and CSDH via MMA embolization; the hematomas of all patients gradually decreased and disappeared after the procedure, with no instances of reexpansion nor recurrence of the hematoma during follow-up. Although studies have shown that the use of any embolic material (liquid or solid) could achieve the desired effect for the occlusion of the MMA, liquid embolic agents needed to pay attention to whether there is anastomotic branches between the internal and external carotid arteries to prevent the liquid embolic agent flowed into the brain and caused inappropriate embolism (6,21).…”

Endovascular Treatment of Chronic Subdural Hematomas through Embolization: A Pilot Study with a Non-Adhesive Liquid Embolic Agent of Minimal Viscosity (Squid)

“…The penetration of the embolic agent deep into the dependent vasculature of the MMA is considered crucial by most authors. The following embolic agents have been used and were reported together with good results: Polyvinyl alcohol particles (PVA) [ 2 , 28 , 29 , 37 , 38 ] Embospheres [ 39 , 40 ] n-butyl cyanoacrylate (nBCA) [ 25 , 36 , 39 , 41 ] PVA and nBCA [ 42 , 43 ] Absolute alcohol [ 44 ] Onyx [ 35 , 45 , 46 ] Phil: Pending Squid: Pending Coils [ 37 , 47 ]. …”

Traumatic epidural hematoma treated with endovascular coil embolization

“…A review of the literature, including the present case, revealed 15 articles of embolization for EDH in 153 patients [ Table 1 ]. [ 3 , 5 , 8 , 19 , 21 , 22 , 24 , 27 , 29 , 32 , 36 , 39 , 41 , 42 ] In 98.0% of cases (150/153), EDH occurred due to traumatic injury; 1 case (0.69%) was caused by a nontraumatic dural arteriovenous fistula. [ 39 ] The MMA was embolized in all cases (100%), leading to successful outcome with no complications in all but 1 complicated case, where the patient died of hypoxic injury and medical conditions 2 months after treatment for intracranial hemorrhage requiring an external ventricular drain.…”