Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Predictors of Clinical and Radiographic Failure from 636 Embolizations

ARISE I Consensus Statement on the Management of Chronic Subdural Hematoma

“…MMAE is generally safe and probably remains effective for patients with thrombocytopenia 73 and those on anticoagulation medications 74 ; however, perioperative antithrombotic medication use may increase the rates of cSDH recurrence following MMAE. 39,75 As such, variability in these factors may have a large impact on treatment outcomes and confound results. Finally, as previously discussed, the effect of treatment on neurological outcomes of patients with cSDH is difficult to measure as patients present with a wide range of medical comorbidities and neurological symptoms; better tools to account for comorbidities and cSDH disease severity need to be developed, and whether MMAEs improve clinical outcomes beyond the need for repeat treatment will need to be explored further.…”

Letter: Middle Meningeal Artery Embolization in Adjunction to Surgical Evacuation for Treatment of Subdural Hematomas: A Nationwide Comparison of Outcomes With Isolated Surgical Evacuation

“…Are indicators of the presence or absence of MMA staining important? A more likely explanation, as mentioned in the article, 2 is that the CSDH membrane receives additional arterial supply, such as from the occipital artery or accessory MMA, in addition to contralateral dural arterial supply. Is digital subtraction angiography of the bilateral external carotid arteries, rather than just MMA, required to identify the selected artery?…”

“…Another recent study examined the factors that could foretell CSDH treatment failure with MMAE. 2 In the retrospective study involving 530 patients and 636 middle meningeal artery (MMA) embolization procedures, it was found that a small MMA diameter (1.5 mm) is independently associated with both clinical and radiographic failures. This suggests that the size of the MMA plays a significant role in determining the success of the procedure.…”

Commentary: Recurrent Chronic Subdural Hematoma After Burr-Hole Surgery and Postoperative Drainage: A Systematic Review and Meta-Analysis

“…The fundamental question is when confronted with a CSDH, what to choose from a menu of multiple medical (dexamethasone, tranexamic acid, and NSAIDS), endovascular (middle meningeal artery embolization), or surgical (bedside drain, burr-hole irrigation, and craniotomy) choices. 2-13 Current management is usually prescribed for an older patient usually on anticoagulant/antiplatelet medications with a high frailty index. One crucial question is how to select candidates for burr-hole surgery.…”