2019
DOI: 10.1136/neurintsurg-2019-014730
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Middle meningeal artery embolization for the management of chronic subdural hematoma

Abstract: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diagnoses in adults. The disease is fundamentally a disorder of the meningeal blood vessels, and options exist for the minimally invasive neuroendovascular management. We review the potential role for the endovascular management of cSDH within the context of a discussion of the epidemiology, pathophysiology, and conventional management of this disease.

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Cited by 141 publications
(139 citation statements)
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“…This hypothesis should be taken in consideration in the diagnostic work up of patients with symptomatic CSH since the specific therapy required is the EBP procedure (Pattichis & Slee, 2016). In the present case, presenting recurrent symptoms of CSH and orthostatic headache, suggestive for intracranial hypotension, MMA embolization associated with EBP, allowed complete symptoms resolution (Fiorella & Arthur, 2019).…”
Section: Discussionmentioning
confidence: 70%
“…This hypothesis should be taken in consideration in the diagnostic work up of patients with symptomatic CSH since the specific therapy required is the EBP procedure (Pattichis & Slee, 2016). In the present case, presenting recurrent symptoms of CSH and orthostatic headache, suggestive for intracranial hypotension, MMA embolization associated with EBP, allowed complete symptoms resolution (Fiorella & Arthur, 2019).…”
Section: Discussionmentioning
confidence: 70%
“…On the other hand, asymptomatic and/or small cSDHs without brain compression are typically treated conservatively and followedup closely with serial imaging. Successful MMA embolization for cSDH has been described in small case reports and series over the past several years (11)(12)(13)(14)(15)(16)(17)(18). More recently, Ng et al (19) in 2020 conducted a randomized controlled trial comparing surgery with and without MMA embolization in patients with cSDH.…”
Section: Introductionmentioning
confidence: 99%
“…There have been observational speculations about the pathophysiology of cSDH recurrence. The dominant theory revolves around rupture of bridging veins traversing from the brain to draining dural sinuses within the subdural space (12), but there are several characteristics of cSDH that argue for a more complex process: (1) cSDH takes several weeks to grow (13) that is longer than expected from a venous source of bleeding; (2) cSDH often extends across the cerebral convexities away from medial draining sinuses where bridging veins are predominantly located; and (3) acute hemorrhage is only observed in 9% of patients with growing cSDH (14), suggesting acute hemorrhage is not the etiology for a majority of cases. Alternative explanations have centered on a self-propagating cycle of inflammation, angiogenesis, exudation, and hemorrhage, which is described below.…”
Section: Chronic Subdural Hematoma: Pathophysiologymentioning
confidence: 99%
“…Whether it is causative or adaptive in recurrent cSDH, or simply a co-occurrence, an ophthalmic origin of MMA prohibits embolization as a treatment for cSDH. Another technical consideration is the choice of embolizing material: majority of studies have utilized polyvinyl alcohol (PVA) particles (14) and few have used liquid embolic material. There are theoretical advantages for particles or liquid materials: particles have more distal penetrance and block most distal branches that may receive collateral perfusion from other arteries than the MMA, however, particles are not opaque and they are hard to visually track.…”
Section: How Does Blocking Arterial Blood Flow Cure Subdural Hematoma?mentioning
confidence: 99%