Middle Meningeal Artery Embolization for Recurrent Chronic Subdural Hematoma: A Case Series

BACKGROUND: Embolization of the middle meningeal artery (MMA) has recently been proposed as an alternative to surgery for treatment of chronic subdural hematoma (SDH). There is increasing evidence that fragile neovasculature arising from distal branches of the MMA found within the membrane that forms around a chronic SDH is responsible for high recurrence rates due to chronic, repeated rebleeding. Embolization of the MMA could thus potentially eliminate the blood supply to this membrane and prevent further rebleeding. METHODS: The cases of 6 patients with 7 recurrent SDHs treated with MMA embolization with polyvinyl alcohol particles were retrospectively reviewed. RESULTS: MMA embolization was performed successfully in all 6 patients with no complications. Of the 7 SDHs treated, 1 required surgical reevacuation due to recurrence. The other 6 were able to avoid surgery, with reduction in size from 12 mm to 11 mm over 3 weeks, 14 mm to 9 mm over 9 weeks, 21 mm to 5 mm over 31 weeks, 17 mm to 9 mm over 12 weeks, 18 mm to 3 mm over 8 weeks, and 25 mm to 6 mm over 24 weeks. All patients had resolution of symptoms at longest follow-up. CONCLUSIONS: In this case series of 6 patients harboring 7 recurrent, chronic SDHs, 6 of the 7 were successfully treated with MMA embolization and able to avoid surgery for reevacuation, suggesting that this minimally invasive technique may represent an effective alternative to surgery.