Full Text Article Open Access

Citation: Yee Phyo WS. Middle meningeal artery embolization for chronic subdural hematomas: Adjunctive or standalone?

Submit your manuscript: www.jmedicalresearch.com

Editorial

Middle meningeal artery embolization for chronic subdural hematomas:

Adjunctive or standalone?

Dr. Wint Shwe Yee Phyo

Department of Neurosurgery

Yangon University of Medicine II, Myanmar

Chronic subdural hematoma (CSDH) is a frequent condition in neurosurgical practice. Primary

surgical evacuation (Burr-hole drainage) remained the treatment’s gold standard despite the

progress of several endovascular alternatives [1]. CSHD recurrence is observed in more than 15%

of operated cases. Surgical rescue is needed in most of these situations [2,3].

Middle meningeal artery embolization (MMAE) is a recent minimally invasive approach in CSHD

management. Several embolization agents and protocols used in this technique were associated

with lower short-term CSHD recurrence rates and shorter hospital stay [4].

MMAE was initially indicated for intractable refractory CSDH cases. Recently, MMAE indications were

extended to several other clinical situations specially in elderly patients, concomitant anticoagulation

treatments and in case of septic or metastatic CSHD [5,6]. MMAE modalities and techniques are still

heterogeneous and non-consensual. The use of embolic materials reaching more distally was

correlated with lower recurrence rate. Some authors are considering liquid MMA embolization agents

as safer and more effective [7].

Associated to surgery, MMAE significantly decreases surgical treatment failure rate and the need for

second rescue with acceptable added morbidity and mortality [8]. Over the last few years MMAE is

proving to be a safe non-invasive treatment option with favorable outcomes and lower recurrence

rate [8].Standalone MMAE may be equivalent to MMAE and surgery association regarding recurrence

rate, surgical rescue and inpatient hospital stay [9] . Several studies have revealed that MMAE may

stop the neovascularization process which is the main cause of traumatic CSHD recurrence [10].

Furthermore, MMAE is safer and more effective in the management of CSHD for patient with

malignant coagulopathies [11]. MMAE is a promising alternative to surgery in appropriately selected

CSHD cases. However, evidence-based assessment of long-term efficacy, durability and exact patient

centered indications is needed before considering this endovascular approach as a viable definitive

treatment of CSHD [12].

References

[1]Ng S, Derraz I, Boetto J, Dargazanli C, Poulen G, Gascou G, et al. Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing

hematoma volume resorption. J Neurointerv Surg. 2020;12(7):695-99.

[2]Musmar B, Spellicy S, Salim H, Abdelgadir J, Zomorodi A, Cutler A, et al. Comparative outcomes of middle meningeal artery embolization with statins versus embolization alone in the treatment of chronic

subdural hematoma: a systematic review and meta-analysis. Neurosurg Rev. 2023; 46:262.

[3]Sattari SA, Yang W, Shahbandi A, Feghali J, Lee RP, Xu R, et al. Middle meningeal artery embolization versus conventional management for patients with chronic subdural hematoma: A systematic review and

meta-analysis. Neurosurgery. 2023;92:1142-54.

[4]Srivatsan A, Mohanty A, Nascimento FA, Hafeez MU, Srinivasan VM, Thomas A, et al. Middle meningeal artery embolization for chronic subdural hematoma: Meta-analysis and systematic review. World

Neurosurg. 2019;122:613-19.

[5]Abdollahifard S, Farrokhi A, Yousefi O, Valibeygi A, Azami P, Mowla A. Particle embolic agents for embolization of middle meningeal artery in the treatment of chronic subdural hematoma: A systematic review

and meta-analysis. Interv Neuroradiol. 2024;30:94-104.

[6]Ku JC, Dmytriw AA, Essibayi MA, Banihashemi MA, Vranic JE, Ghozy S, et al. Embolic agent choice in middle meningeal artery embolization as primary or adjunct treatment for chronic subdural hematoma: A

systematic review and meta-analysis. AJNR Am J Neuroradiol. 2023;44:297-302.

[7]Mowla A, Abdollahifard S, Farrokhi A, Yousefi O, Valibeygi A, Azami P. Middle meningeal artery embolization with liquid embolic agents for chronic subdural hematoma: A systematic review and Meta-analysis.

J Vasc Interv Radiol. 2023 ;34:1493-1500.e7.

[8]Chen H, Colasurdo M, Kan PT. Middle meningeal artery embolization as standalone treatment versus combined with surgical evacuation for chronic subdural hematomas: systematic review and meta-analysis.

J Neurosurg. 2023; 140:819-25.

[9]Jumah F, Osama M, Islim AI, Jumah A, Patra DP, Kosty J,et al. Efficacy and safety of middle meningeal artery embolization in the management of refractory or chronic subdural hematomas: a systematic

review and meta-analysis. Acta Neurochir (Wien). 2020; 162:499-507.

[10]Henry J, Amoo M, Kissner M, Deane T, Zilani G, Crockett MT, et al. Management of chronic subdural hematoma: A systematic review and component network meta-analysis of 455 Studies With 103 645

Cases. Neurosurgery. 2022;91:842-55.

[11]Kojima A, Hosoi M, Hayashi K, Fukumura M, Saga I. Middle meningeal artery embolization for refractory chronic subdural hematoma associated with acute myeloid Leukemia: A Case Report. J Neuroendovasc

Ther.2024;18:47-52.

[12]Ironside N, Nguyen C, Do Q, Ugiliweneza B, Chen CJ, Sieg EP, et al. Middle meningeal artery embolization for chronic subdural hematoma: a systematic review and meta-analysis. J Neurointerv Surg.2021

;13:951-57.