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Embolization of the middle meningeal artery in patients with chronic subdural hematoma—a systematic review and meta-analysis

  • Review Article - Vascular Neurosurgery - Other
  • Published:
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Abstract

Background

Chronic subdural hematoma (CSDH) remains a neurosurgical condition with high recurrence rate after surgical treatment. The primary pathological mechanism is considered to be repeated microbleedings from fragile neo-vessels within the outer hematoma membrane. The neo-vessels are supplied from peripheral branches of the middle meningeal artery, and embolization of MMA (eMMA) has been performed to prevent re-bleeding episodes and thereby CSDH recurrence.

Objective

To evaluate the published evidence for the effect of eMMA in patients with recurrent CSDH. Secondarily, to investigate the effect of eMMA as an alternative to surgery for primary treatment of CSDH.

Method

A systematic review of the literature on eMMA in patients with recurrent CSDH was conducted. PubMed, Embase, and Cochrane databases were reviewed using the search terms: Embolization, Medial Meningeal Artery, Chronic Subdural Haematoma, and Recurrence. Furthermore, the following mesh terms were used: Chronic Subdural Haematoma AND embolization AND medial meningeal artery AND recurrence. Eighteen papers were found and included. No papers were excluded. The number of patients with primary CSDH and the number of patients with recurrent CSDH treated with eMMA were listed. Furthermore, the number of recurrences in both categories was registered.

Results

Eighteen papers with a total of 191 included patients diagnosed with CSDH treated with eMMA for primary and recurrent CSDH were identified. Recurrence rate for patients treated with eMMA for recurrent CSDH was found to be 2.4%, 95% CI (0.5%; 11.0%), whereas the recurrence rate for patients treated with eMMA for primary CSDH was 4.1%, 95% CI (1.4%; 11.4%).

Conclusion

eMMA is a minimally invasive procedure for treatment of CSDH. Although this study is limited by publication bias, it seems that this procedure may reduce recurrence rates compared with burr hole craniostomy for both primary and recurrent hematomas. A controlled study is warranted.

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Authors and Affiliations

  1. Department of Neurosurgery, Aarhus University Hospital, Palle-Juul Jensens Boulevard 165, 8200, Aarhus, Denmark

    Mette Haldrup, Baskaran Ketharanathan & Bo Bergholt

  2. Department of Public Health, University of Southern Denmark, Winsløwsvej 9b, 5000, Odense C, Denmark

    Birgit Debrabant

  3. Nordic EMBL Partnership for Molecular Medicine & Department of Biomedicine, DANDRITE–Danish Research Institute of Translational Neuroscience, Aarhus University, Aarhus, Denmark

    Ole Søndergaard Schwartz

  4. Department of Neuroradiology, Aarhus University Hospital, Palle-Juul Jensens Boulevard 165, 8200, Aarhus, Denmark

    Ronni Mikkelsen

  5. Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

    Kåre Fugleholm & Thorbjørn Søren Rønn Jensen

  6. Department of Neurosurgery, Odense University Hospital, Clinical Institute, University of Southern Denmark and BRIDGE (Brain Research – Inter Disciplinary Guided Excellence), Sdr. Boulevard 29, DK-5000, Odense C, Denmark

    Frantz Rom Poulsen

  7. Department of Neurosurgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark

    Lærke Velia Thaarup

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  1. Mette Haldrup
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Correspondence to Mette Haldrup.

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This article is part of the Topical Collection on Vascular Neurosurgery - Other

Accepted for presentation at Scandinavian Neurosurgical Congress 19-22/6-19, Stockholm, Sweden

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Haldrup, M., Ketharanathan, B., Debrabant, B. et al. Embolization of the middle meningeal artery in patients with chronic subdural hematoma—a systematic review and meta-analysis. Acta Neurochir 162, 777–784 (2020). https://doi.org/10.1007/s00701-020-04266-0

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