Abstract
Chronic subdural hematoma (cSDH) is a common pathology that typically affects the elderly. It is believed to occur due to injury to the dural border cells, which creates an inflammation/proliferation reaction. Ineffective repair leads to the formation of a new external layer of cells and fragile capillaries, which damage easily and can worsen the condition. Conventionally, asymptomatic cSDH is managed by observation, and symptomatic cases are treated by surgical evacuation. Unfortunately, recurrence rates of the SDH following surgical evacuation can be high. One treatment option for SDH involves embolization of the middle meningeal artery (MMA). The MMA provides blood supply to the dura mater and feeds the membrane capillaries covering the SDH. MMA embolization blocks the blood flow to this system and can promote hematoma resolution. In this paper, we review the existing literature on MMA embolization and discuss the underlying pathophysiology of cSDH.
Highlights
Chronic subdural hematoma is a common disease characterized by an organized collection of blood beneath the dural membrane
Kim compared middle meningeal artery (MMA) embolization against burr hole craniostomy for patients who had already undergone prior surgical evacuation of Chronic subdural hematoma (cSDH) [42]. They found that MMA embolization was successful in all except one case (3.8%), which eventually underwent spontaneous regression
The author recommended that MMA embolization must be considered as the preferred treatment in recurrent cSDH
Summary
Chronic subdural hematoma (cSDH) is a common disease characterized by an organized collection of blood beneath the dural membrane. Mino et al evaluated four patients who presented with recurrent cSDH following single burr hole surgery [34] They performed superselective angiography of the MMA artery in these patients. Kim compared MMA embolization against burr hole craniostomy for patients who had already undergone prior surgical evacuation of cSDH [42]. They found that MMA embolization was successful in all except one case (3.8%), which eventually underwent spontaneous regression. The author recommended that MMA embolization must be considered as the preferred treatment in recurrent cSDH In another comparative study, Matsumoto et al evaluated different methods of management in patients with refractory cSDH, which is defined as those presenting with two or more recurrences. Rajah et al have successfully used both non-adhesive (Onyx®) and adhesive (cyanoacrylate) liquids for MMA embolization in the management of cSDH [45]
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