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Middle Meningeal Artery Embolization in the Management of Chronic Subdural Hematoma: a Comprehensive Review of Current Literature

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Abstract

Purpose of Review

Chronic subdural hematoma (cSDH) is a common intracranial hemorrhagic disorder with a high incidence rate among the elderly. While small, asymptomatic cSDH may resolve spontaneously, surgical intervention has been the treatment of choice for larger, symptomatic cases. Surgical evacuation of cSDH may be associated with high rates of recurrence, and even asymptomatic cSDH cases tend to progress. Over the last few years, middle meningeal artery (MMA) embolization has proven to be a safe non-invasive treatment of choice with favorable outcomes and a low recurrence rate. The ensuing paper discusses current treatment modalities for cSDH and reviews existing literature on the anatomy of MMA and its embolization as a treatment option for cSDH.

Recent Findings

Recent studies show that traumatic head injury leading to subdural hemorrhage can induce neovascularization that may initiate a cycle of recurrent subdural hematoma. Distal branches of MMA supply blood to the dural layers. Several studies have revealed that embolization of the MMA can stop the neovascularization process and blood flow. In addition, patients who underwent MMA embolization had a significantly quicker brain re-expansion and lower recurrence rate.

Summary

Although the management of cSDH is still very much a dilemma, recent research findings bring MMA embolization to light as a promising treatment alternative and adjunctive therapy.

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Data Availability

Data derived from public domain resources

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Authors and Affiliations

  1. Department of Neurosurgery, Lenox Hill Hospital, New York, NY, USA

    Likowsky L. Desir, Vinayak Narayan, Jason Ellis, David Gordon, David Langer, Rafael Ortiz & Yafell Serulle

  2. City University of New York School of Medicine, New York, NY, USA

    Likowsky L. Desir

  3. Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Yafell Serulle

  4. Neuroendovascular Surgery, Phelps Hospital, Sleepy Hollow, NY, USA

    Yafell Serulle

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  1. Likowsky L. Desir
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  2. Vinayak Narayan
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Correspondence to Yafell Serulle.

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Likowsky L. Desir, Vinayak Narayan, Jason Ellis, David Gordon, David Langer, Rafael Ortiz, and Yafell Serulle declare that they have no conflict of interest.

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Desir, L.L., Narayan, V., Ellis, J. et al. Middle Meningeal Artery Embolization in the Management of Chronic Subdural Hematoma: a Comprehensive Review of Current Literature. Curr Neurol Neurosci Rep 23, 109–119 (2023). https://doi.org/10.1007/s11910-023-01262-6

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