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

Abstract

MMA embolization could present a minimally invasive and low-risk initial treatment alternative to surgery for symptomatic chronic SDH when clinically appropriate.

Ultrasonographic assessment of the maxillary artery and middle meningeal artery in the infratemporal fossa

“…The MMA has been in the center of interest of many studies regarding cephalalgia and migraine, due to the proposed vasodilatation‐based pathophysiological mechanisms, and hemodynamic studies (preferably noninvasive) are desperately needed . In the era of endovascular procedures, Doppler sonography of the MMA may be used to evaluate the outcomes of treatment of malformations and chronic subdural hematomas . MMA may contribute to the direct and indirect blood supply in chronic ischemic disease and Moya‐Moya, and exhibit increased flow velocities, with decreased RI …”

“…On the other hand, there are no studies reporting visualizing the MMA or assessing its blood flow. Ultrasonographic visualization of the MXA and its MMA branch in ITF may allow their assessment in headache and migraine, intracranial hematomas, and extracranial‐intracranial by‐pass surgery, as well as to assess collateral flow development in carotid occlusive diseases and the vascularization of tumors and vascular malformations of the facial region …”

“…Ultrasonographic visualization of the MXA and its MMA branch in ITF may allow their assessment in headache and migraine, intracranial hematomas, and extracranial-intracranial by-pass surgery, as well as to assess collateral flow development in carotid occlusive diseases and the vascularization of tumors and vascular malformations of the facial region. 2,[6][7][8][9][10] The aim of this study was to develop and present a method to visualize the MMA and MXA in the ITF, correctly identify these two arteries based on their anatomy and blood-flow features, and describe their hemodynamic characteristics in a group of subjects without vascular disease. After the visualization of the arteries, we measured the depth of insonation (DI), and obtained the pulsed Doppler signal of the MXA and the MMA, on which we measured the angle corrected peak We anticipated that the Doppler spectrum characteristics of MXA and MMA would be intermediate between those of extra and intracranial arteries 12,13 (Figure 3).…”

Embolization of Middle Meningeal Artery for the Treatment of Headaches Induced by Chronic Subdural Hematoma: A Case Report

“…Literature analysis by Tempaku et al of 21 patients who underwent MMA embolization as secondary therapy or concurrent therapy (in tandem with surgery) after attempts at surgical evacuation had failed found no incidence of recurrence . More recently, Link et al have reported on 5 patients who underwent embolization as primary therapy, also with promising results …”

“…4 More recently, Link et al have reported on 5 patients who underwent embolization as primary therapy, also with promising results. 5 Although surgical evacuation remains the most common surgical option, this approach often requires prolonged time off of blood thinning medication. 3 There are only a few contraindications to endovascular embolization of the MMA, and if no anastomosis exists between external carotid artery ethmoidal branches and the ophthalmic artery it can be performed with minimal risk, under conscious sedation.…”