Middle Meningeal Artery Embolization to Treat Chronic Subdural Hematoma
Robert F. Rudy, Joshua S. Catapano, Ashutosh P. Jadhav, Felipe C Albuquerque, Andrew F. Ducruet
Abstract
Background: Chronic subdural hematoma is associated with high rates of perioperative complications and recurrence. Methods: The classic treatments are observation or surgical evacuation. Middle meningeal artery embolization is a recently emerging procedure that has evolved as the neuroendovascular community has gained collective experience. This review summarizes the pathophysiology of chronic subdural hematoma, reviews the classic treatment strategies, discusses the advent and use of middle meningeal artery embolization, and describes the contemporary technical approach to middle meningeal artery embolization. Results: Embolization has the advantages of targeting the vascular supply of the neomembranes implicated in chronic subdural hematoma pathophysiology and avoiding surgical or bedside drainage in a population associated with significant comorbidities. Conclusions: Middle meningeal artery embolization is increasingly used both as an adjunct treatment to surgical evacuation and as a stand-alone method for managing this challenging entity.