Middle Meningeal Artery Embolisation effective treatment option to surgery for chronic Subdural Hematoma

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases that primarily affects the elderly population, with an estimated incidence of 10/100,000. Surgical evacuation of hematoma, conducted using burr-hole trephination and drainage, is currently considered the gold standard for symptomatic CSDH. Elderly patients, who comprise the majority of CSDH patients, however, have a high risk of perioperative complications (up to 32%) for surgical intervention due to their old age and various comorbidities. The recurrence rate of surgical treatment, moreover, is reported as 10-30% at 1-8 week intervals. MMAE is a technique that has recently emerged as an alternative or adjunctive to surgical procedures.

CSDH presents as a severe headache, focal neurological lateralizing signs, or mental status change due to the mass effect. It occurs mainly in the elderly population because age-related brain atrophy renders cortical veins prone to shear injury and bleeding caused by minor head trauma. Over time, the hematoma develops pseudomembranes containing macrophages and giant capillaries that are connected to the termini of the middle meningeal arterioles. This vascularity is considered to be the main pathophysiology of hematoma expansion, mixed chronology of hematoma nature, and high recurrence rate after surgery. The mainstay of treatment for CSDH is surgery, conducted using burr-hole trephination. However, the recurrence rate after surgery is reportedly up to 30%. Elderly patients, who comprise the majority of the CSDH patient population, are at greater risk of surgical complications due to their comorbidities.