Dear Editor

In response to the letter by A. Celal İplikçioğlu, MD, with the title Embolization of the middle meningeal artery in patients with chronic subdural hematoma—a systematic review and meta-analysis, we thank Dr. İplikçioğlu for the relevant response to our systematic review and meta-analysis of embolization of the middle meningeal artery (eMMA) [1], where Dr. İplikçioğlu refers to an abstract describing how clipping of the middle meningeal artery (MMA) for chronic subdural hematoma (CSDH) has been performed in Turkish patients.

Surgical occlusion of the middle meningeal artery (soMMA) was described by William Rose in 1890 during surgical removal of the Gasserian ganglion for trigeminal neuralgia [3]. In this setting, the occlusion was performed extracranially by ligation of the internal maxillary artery. This was also described by Plummer in his comprehensive review of the surgical anatomy of MMA 6 years later [2]. Plummer further described how he was able to occlude the main trunk of MMA by a 2-cm pterionic burr hole in 26/48 cadaver heads and only the anterior division in the 12.

We have not been able to identify any previous publications of soMMA for treatment of CSDH. Over the past year, in the setting of the Danish Chronic Subdural Hematoma Study (DACSUHS), we have launched an effort to define the surgical anatomy and technical feasibility of soMMA for CSDH. This paper will be submitted for publication shortly. We are delighted to discover that this procedure has actually been done recently in patients. We are planning a national multicenter randomized clinical trial to assess the effect of this as an adjuvant treatment for recurrent CSDH. We understand that the results of the Turkish study have not been published, but we would still appreciate full details on this study as we may gain important knowledge for our own study.