Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Review

Abstract

Middle meningeal artery embolization (MMAE) for chronic subdural hematomas (cSDHs) has evolved as a potential treatment alternative for these lesions. The indications for using this treatment modality and the pathophysiology of cSDHs are an area of considerable interest. A retrospective review was performed including all major papers addressing this topic. Although considered a relatively new treatment option, MMAE for cSDHs is gaining widespread popularity. There are many questions that need to be addressed regarding its indications, some of which are the subject of ongoing clinical trials. The efficacy of this treatment modality in carefully selected patients has also provided new insights into the potential pathophysiology of cSDHs. This concise review will focus on the current evidence supporting the use of embolization in the treatment of this disease and highlight unanswered relevant clinical questions regarding MMAE indications and technique.

Featured minimally invasive therapeutic approach for chronic subdural hematoma: Embolization of middle meningeal artery - A narrative review

“…When this initial damage is not repaired, the stimulated cycle of hyperfibrinolysis, inflammation, and angiogenesis results in subdural neomembrane development [ Figure 2 ]. [ 1 ] These neomembranes that form the capsule of the hematoma collection take weeks to months to develop and are immature forms. [ 4 ] Continued cytokine release further enhances angiogenesis and promotes blood flow to the subdural space.…”

“…[ 30 ] It is used alone or adjunctive to surgery. [ 1 31 ] It is particularly useful when patients need to continue anticoagulant or antiplatelet therapy. [ 1 ]…”

“…[ 32 ] Depending on the cause of the bleeding, it can be done alone or in combination with other surgical procedures. [ 1 ]…”

“…Chronic subdural hematoma (c-SDH) is a frequent and serious neurological disease. [ 1 ] Its yearly incidence is about 10/100,000 and is estimated to increase steadily in the next years. [ 2 ] This disease mainly affects older people.…”

Commentary: Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Review

“…The authors of the current submission 1 have reviewed the pathogenesis, pathophysiology, and management of chronic subdural hematoma including its evolution from torn dural border cell layer. Extravasation of cerebrospinal fluid and blood into the subdural space precipitates an inflammatory cascade involving cytokines and interleukins, followed by angiogenesis with participation of different vascular factors such as vascular endothelial growth factor, cyclooyxygenase-2, transforming growth factor-β1, and platelet-derived growth factor, The authors argue that sinusoidal neovascularization results in repeated hemorrhage and a vicious cycle of acute or chronic SDH cavity.…”