Middle meningeal embolization for chronic subdural Hematoma: A case series of 7 patients and review of time course of resolution

Chronic subdural hematoma (CSDH) is common in elderly after a mild or trivial head injury. The concern for embolization is the period to wait, as compared to immediate relief of mass effect from surgery. Thus, a combination approach is advocated in our center when in doubt. We here reported our initial experience and observation with respect to time course of resolution. We retrospectively reviewed all the patients with CSDH undergoing Onyx middle meningeal artery (MMA) embolization with curative intent and excluded patients for palliative treatment in a neurosurgical center in Hong Kong. Four (50%) CSDH were treated with MMA embolization alone and 4(50%) CSDH were treated with both surgery and MMA embolization. For the 4 patients with MMA embolization alone, one(25%) achieved significant reduction at 6 weeks and 3(75%) achieved resolution at 3 months. For the 4 CSDH with both surgery and MMA embolization, all have resolution at the first follow-up imaging, two(50%) at 6 weeks and 2(50%) at 3 months. There were no procedure related complications, and there were no recurrence nor reoperation in all CSDH. MMA embolization is safe and feasible within the framework of surgery to cure and prevent recurrence.