Middle Meningeal Artery Embolization with Isolated Use of Coils for Treatment of Chronic Subdural Hematomas: A Case Series

Abstract

Middle meningeal artery embolization (MMAE) is a novel approach for treatment of chronic subdural hematoma (cSDH). Studies comparing different procedural techniques for MMAE are lacking. It is unclear whether isolated use of coils results in suboptimal outcomes compared to when particle embolization is also performed. The objectives of this study are to describe the outcomes of coil-only MMAE and comparethem with those of combined use of coils and particles. A single-institution retrospective study of cSDH cases treated by MMAE was performed. Clinical outcomes, need for rescue surgery, and changes in hematoma's size were compared between the coil-only and coil+particle groups. Ninety-four hematomas in 78 patients were included. Twelve cases were treated by a coil-only MMAE procedure, often due to presence of dangerous ophthalmic collaterals. No treatment-related complications were observed in the coil-only group. There was no significant difference between the coil-only and coil+particle groups in baseline hematoma axial thickness, volume, midline shift, and duration of follow-up. The rate of need for rescue surgery was similar between the 2 groups (8.3% vs. 8.5%; P= 0.98). Coiling alone resulted in a similar percentageof reduction in cSDH volume (68.3% vs. 71.8%; P= 0.8) and rate of achieving ≥50% reduction in volume (81.8% vs. 76.3%; P= 0.68) compared to coils+particles. Isolated use of coils for endovascular treatment of cSDHs can be as effective as adjunct use of particle embolization. This method eliminates the risks of cranial nerve and visual complications associated with MMAE, can prevent procedural abortion due to presence of dangerous anastomoses, and reduces the technical complexity of the procedure.