Extensive Roles and Technical Advances of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Abstract

Chronic subdural hematoma (CSDH) is a common pathology that typically affects the elderly in Japan, an aging society. Burr-hole irrigation is the standard treatment, but middle meningeal artery (MMA) embolization is a minimally invasive alternative. MMA embolization for CSDH has frequently been reported in recent years, and many technical innovations to improve clinical outcomes have been de-scribed. Embolic materials reaching more distally are found to avoid recurrences after MMA emboliza-tion. As a result, various studies have described the superiority of embolizing the anterior and posterior branches of the MMA, the advantages of embolic materials reaching beyond the midline, and a high degree of distal penetration using a “sugar rush technique” in which 5% soluble glucose is in-jected through an intermediate catheter during MMA embolization. Radiographically, reports have described the importance of a “bright falx” sign obtained by infiltrating embolic material beyond the midline and post-embolization enhancement of the dura, capsular membrane, septations, and sub-dural hematoma fluid as indicators of the spread of embolic materials. This review provides an over-view of the current status and future challenges in MMA embolization for CSDH, focusing on technical aspects to improve clinical outcomes.