Efficacy of Middle Meningeal Artery Embolization for Organized Chronic Subdural Hematoma

Objective: This study evaluated the efficacy of middle meningeal artery (MMA) embolization for organized chronic subdural hematoma (OCSDH). Methods: Between 2013 and 2017 at our institution, 11 consecutive patients with 14 OCSDH lesions required MMA embolization, accounting for 4.5% of the 314 patients treated for chronic subdural hematoma (CSDH) in this period. Initially, all lesions underwent burr-hole surgery (BHS) under local anesthesia. At the regrowth, BHS was first performed under local anesthesia. OCSDH was diagnosed based on second-operative findings and postoperative CT or magnetic resonance imaging of the brain, and MMA embolization was performed for OCSDH. We investigated the efficacy of MMA embolization in reducing the hematoma and preventing regrowth of OCSDH. Results: In the second surgery, 12 lesions underwent BHS. Additionally, two lesions were treated with small craniotomy after BHS under local anesthesia. In all lesions, MMA embolization was performed within 3 weeks after the second surgery. In all, 12 lesions improved on brain CT within 2–4 weeks. Two lesions underwent craniotomy and membranectomy under general anesthesia, 2 and 10 days after MMA embolization. In one case, the BHS and small craniotomy were insufficient to reduce the mass effect. In the other case, infectious CSDH was diagnosed at craniotomy. Conclusions: MMA embolization may be effective additional modality for OCSDH after BHS.