Middle meningeal artery embolisation for chronic subdural haematomas

The condition

2.1 Chronic subdural haematoma (CSDH) is characterised by a pathological collection of blood in the subdural space, and usually has an insidious onset and progression. It may begin forming several days or weeks after bleeding initially starts. Bleeding is usually caused by a head injury, which may be minor in nature.

Current treatments

2.2 People who are asymptomatic or have minor symptoms with smaller haematomas are usually offered conventional treatment with careful monitoring and medical management. In contrast, people who have more severe symptoms and larger haematomas, and who have acceptable surgical risks, are generally offered burr hole surgery or a craniotomy.

The procedure

2.3 This procedure is done using general or local anaesthesia, under fluoroscopic guidance. A catheter is inserted into the common femoral or radial artery, and a microcatheter is then guided into the middle meningeal artery (MMA). Angiography is used to select MMA branches for embolisation and to detect collateral vessels.

2.4 If there are no significant collateral vessels, target branches are embolised. If there are significant collateral vessels, they are either occluded using coils before embolisation, or the microcatheter is advanced more distally to avoid them. Once there is no flow in the MMA target branches on angiography, the catheters are removed.

2.5 This procedure aims to eliminate the blood supply from the MMA to the membrane around the haematoma and to allow the eventual spontaneous resolution of the haematoma.