Abstract
Middle meningeal artery (MMA) embolization is emerging as apotential treatment of chronic subdural hematomas (CSDHs). The purpose of this study is to describe MMA angiographic anatomy in relation to CSDH embolization. This retrospective monocentric study was performed on imaging data of MMA embolization procedures for CSDH treatment performed between March15, 2018 and April30, 2020. Imaging data, including digital subtraction angiography (DSA) were reviewed independently by two physicians. Discrepancies were resolved by consensus. The MMA bifurcation pattern was analyzed according to an extended Adachi classification. Relations of the MMA with the ophthalmic artery (OA) were also analyzed. In this study, 140 MMAs were analyzed. Dominance of the anterior branch (typeI) was observed in only 57/140 (41%) MMAs with amoderate interobserver agreement for classifying MMA into typeI against all other (κ = 0.53, 95% confidence interval, CI 0.39-0.67). The posterior branch presented aproximal origin (typeA), at the point of emergence of the MMA from the foramen spinosum or its immediate vicinity, in 48/135 (36%) MMAs with avery good interobserver agreement for classifying MMAs into typeA against all other (κ = 0.82, 95% CI 0.72-0.92). An angiographic relationship with the OA was observed in 26MMAs (19%). In the majority of CSDH patients both anterior and posterior branches of the MMA should be targeted to achieve extensive convexity devascularization. Frequent anatomical variations of the MMA with respect to emergence of the posterior branch and MMA orbital branches are expected to impact CSDH embolization strategy.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call