Middle meningeal artery embolization for refractory chronic subdural hematoma

Mandai, Shinya; Sakurai, Masaru; Matsumoto, Yuzo

doi:10.3171/jns.2000.93.4.0686

Cited by 132 publications

(106 citation statements)

References 4 publications

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“…For example, a number of groups have reported on the efficacy of middle meningeal artery embolization in the treatment of refractory chronic subdural hematoma [38,53,58,85]. These series have all demonstrated angiography revealing abnormal vascular stains thought to represent formation of neo-capillaries in the subdural membranes.…”

Section: Adjunctive Techniquesmentioning

confidence: 97%

The surgical management of chronic subdural hematoma

et al. 2011

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Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: "subdural hematoma", "craniotomy", "burr-hole", "management", "anticoagulation", "seizure prophylaxis", "antiplatelet", "mobilization", and "surgical evacuation", alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.

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Section: Adjunctive Techniquesmentioning

confidence: 97%

The surgical management of chronic subdural hematoma

et al. 2011

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“…The hematoma involved a large region of the head and a reticular artery developed from a contralateral OA, and therefore hemostasis by endovascular surgery was selected. There are several reports of the availability of endovascular surgery for the main source of bleeding 15,16,17 . Suzuki et al reported that emergency embolization to manage bleeding from the MMA was a useful technique for patients with acute epidural hematomas 18 .…”

Section: Discussionmentioning

confidence: 99%

A Case of Non-Traumatic Subgaleal Hematoma Effectively Treated with Endovascular Surgery

et al. 2010

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“…5,[8][9][10]17 Information about the MMA on MRA performed before intervention may be useful for developing a strategy for embolizing the MMA. During bur-hole drainage surgery, direct coagulation or embolization of the MMA through a bur hole might facilitate shrinkage of the hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…Several cases of effective embolization to prevent the recurrence of refractory CSDHs were reported recently, 5,[8][9][10]17 which also suggests that embolization of the MMA can intercept the blood supply to the outer membrane of the CSDH and stop hematoma enlargement. The MMA might play an important role in the development of a CSDH.…”

Section: Mechanisms Of Mma Enlargement In a Csdhmentioning

confidence: 99%

“…11 Catheter embolization of the MMA was recently reported to be effective for treating recurrent CSDH by intercepting the blood supply to the outer membrane of the CSDH. 5,[8][9][10]17 Conversely, several studies have reported that MMAs observed with MR angiography (MRA) were enlarged in patients with meningioma, in whom the MMA was a feeding artery to the tumor, 13,18 and in patients with moyamoya disease, in whom the MMA was collateral circulation to the occluded arteries. 6,7 Quantitative measurement of MMA diameter with MRA in patients with migraine has also been reported.…”

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confidence: 99%

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Enlargement of the middle meningeal artery on MR angiography in chronic subdural hematoma

Takizawa¹,

Sorimachi²,

Ishizaka³

et al. 2016

JNS

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obJective The middle meningeal artery (MMA) is suspected to play an important role in the development of chronic subdural hematoma (CSDH). The aim of this study was to clarify whether the MMA was enlarged in patients with CSDHs. Methods The authors retrospectively assessed 55 patients in whom CSDH was diagnosed between 2010 and 2014 and who underwent MR angiography (MRA) after the onset of CSDH. The authors compared MMA diameters between hemispheres with and without CSDHs on MR angiograms. A case-control study was also performed with 55 sex- and age-matched patients with incidental unruptured aneurysms as controls. results In 55 patients with CSDHs, the diameters of the 79 MMAs on the CSDH side were significantly larger than the diameters of the 31 MMAs on the non-CSDH side (p < 0.05). In 24 patients with bilateral CSDHs, no significant difference was found between the MMA diameters on the larger hematoma side and those on the smaller hematoma side. In 13 patients who underwent MRA before the onset of the CSDH, the MMAs on MR angiograms acquired after onset of the CSDH were significantly larger than those on MR angiograms acquired before the CSDH onset (p < 0.05). The diameters of the MMAs in 55 patients with CSDHs were significantly larger than those of the MMAs in the 55 control patients (p < 0.05). coNclusioNs The MMA is enlarged with development of a CSDH. Information about the MMA observed on MRA in patients with CSDHs may be useful in developing a strategy for future treatment of CSDHs.

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Middle meningeal artery embolization for refractory chronic subdural hematoma

Cited by 132 publications

References 4 publications

The surgical management of chronic subdural hematoma

The surgical management of chronic subdural hematoma

A Case of Non-Traumatic Subgaleal Hematoma Effectively Treated with Endovascular Surgery

Enlargement of the middle meningeal artery on MR angiography in chronic subdural hematoma

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