[EMBOLIZATION OF MIDDLE MENINGEAL ARTERY AS A TREATMENT FOR CHRONIC SUBDURAL HEMATOMA].

Abstract

Introduction: Chronic subdural hemorrhage (CSDH) is one of the most common reasons for neurosurgical intervention. The incidence and prevalence of this condition is expected to grow due to aging of the population and the increase in anticoagulation and anti-aggregation prescription drugs. Traditionally, it was accepted that the bleeding originates from bridging veins that drain the brain towards the dural sinuses. However, recent findings exposed an additional underlying mechanism. Trauma leads to separation of the dural border cell layer which induces an inflammatory process that starts positive feedback of leaky blood vessels formation (angidysgensis), which causes blood product leakage that further increases the inflammation. For many years, the disease has been treated conservatively in cases of mild clinical and imaging features, or by surgical evacuation of the hematoma in more severe cases. The literature shows a consistent high recurrence rate of around 30% following a surgical removal of the blood. The newly discovered mechanism inspired the development of a novel treatment method for this entity. Endovascular embolization of the middle meningeal artery (MMA). This method has an excellent efficacy and safety profile, and it can be performed alone or in combination with surgical evacuation. This review presents the epidemiology and mechanisms underlying CSDH, in addition to possible treatment methods, and eventually discuss MMA embolization to increase the awareness of the medical community in Israel to this new approach.