Middle meningeal artery embolisation for chronic subdural haematoma - a UK single-centre experience.

Introduction: Chronic subdural haemorrhage (cSDH) is characterised by a pathological chronic collection of blood in the subdural space. Surgical evacuation is the conventional treatment of larger symptomatic cSDHs. Recurrence after conventional surgery remains an issue in up to 20%, and re-operation after surgical drainage is reported in 12%. Middle meningeal artery (MMA) embolisation selectively targets the distal MMA branches that give rise to the capillary feeders to the cSDH. This study aims to report the clinical and radiological outcomes of this procedure at a tertiary neuroscience centre.

Methods: Clinical and radiological data were collected retrospectively for consecutive MMA embolisation procedures performed over nearly 3 years. These were performed using either embolic particles or liquid agents. Follow-up was done with unenhanced CT head scan head and an outpatient clinic appointment.

Results: Thirty patients (25 males and five females) underwent 39 separate MMA embolisation procedures. The types of cSDHs were 16 trabecular, nine homogenous, seven laminar, and seven separated. MMA embolisation was performed as a primary procedure in 25 cSDHs, as a pre-emptive adjunct to surgical drainage in two cSDHs, as a sole procedure for failed surgical drainage (within the previous 3 months) in 10 cSDHs, and as an adjunct to surgical drainage for previous failed surgical drainage in two cSDHs. The agent used to perform the embolisation was 45-150 µm PVA particle in 34 cSDHs and liquid embolic in five cSDHs. cSDH resorption was radiologically evident in 90% and patients clinically improved in 77% of cases.

Conclusions: MMA embolisation appears to be highly effective and safe to treat cSDH. The use of PVA particles provided a more economical but still effective alternative to liquid embolics. Further studies will be necessary to determine the optimal patient selection and most appropriate embolic agent for MMA embolisation in the clinical setting.