Coil embolization alone appears sufficient for middle meningeal artery embolization

Abstract

Background Middle meningeal artery embolization (MMAE) has shown promise as an alternative treatment for chronic subdural hematoma (cSDH); however, the most effective procedural technique is debated. We sought to assess the safety and efficacy of coil embolization as a stand-alone technique for MMAE in cSDH. Methods A single-center retrospective analysis was performed of patients who underwent MMAE for chronic SDH with coil embolization alone. Results Forty-five patients were included in the study. All underwent successful stand-alone coil MMAE, of which 51.1% were bilateral. Indications for MMAE were varied, but 13.3% of patients required ongoing anticoagulation and another 11.1% had severe thrombocytopenia. Conscious sedation or no sedation was used in 73.2% of patients; 10 patients (22.2%) were scheduled electively and discharged same day. There were no severe or minor procedural complications identified. Of the 45 patients, only 3 (6.6%) underwent unplanned repeat surgical intervention: one patient developed a large recurrence at eight weeks after MMAE and underwent burr hole drainage; the second patient received burr hole drainage prior to MMAE but needed repeat burr hole drainage two weeks later due to residual; the third patient received two burr hole drainages at two and three weeks post MMAE due to persistent disease. Conclusion Stand-alone MMAE with coiling can be performed under conscious sedation as an outpatient procedure and may be sufficient to prevent cSDH recurrence in most cases without the need for particle penetration of cSDH microvascular beds. Larger confirmatory studies are necessary.