Endovascular treatment of chronic subdural hematomas
DOI:
https://doi.org/10.25305/unj.339535Keywords:
chronic subdural hematoma, middle meningeal artery embolization, OnyxTM, transradial approach, endovascular neurosurgery, minimally invasive treatment, military neurotraumaAbstract
Objective: To evaluate the effectiveness of middle meningeal artery embolization (MMAe) in patients with chronic subdural hematoma (cSDH) based on the first 19 clinical cases performed at Mechnikov Dnipropetrovsk Regional Clinical Hospital. To clarify the indications for isolated versus combined treatment of cSDH and to assess the feasibility of the transradial approach.
Materials and methods: A retrospective cohort study was conducted based on the analysis of prospectively collected data from patients with chronic subdural hematomas who underwent MMAe at I.I. Mechnikov Dnipropetrovsk Regional Clinical Hospital between March 24, 2022, and November 6, 2024. The study included 19 patients who underwent endovascular intervention, either as a standalone procedure or in combination with open surgery. Demographic data, etiological factors, clinical presentation, CT, MRI, and DSA findings were analyzed. Treatment effectiveness was assessed at 1, 3, and 6 months postoperatively.
Results: According to the type of treatment, patients were divided into 3 groups: isolated MMAe — 13 patients (68.4%); primary MMAe followed by surgical drainage — 3 patients (15.8%); primary surgical evacuation followed by MMAE — 3 patients (15.8%). Traumatic cSDH was diagnosed in 12 patients (63.2%), while spontaneous cSDH occurred in 7 patients (36.8%), including two cases with mycotic aneurysms of cortical Middle Cerebral Artery (MCA) branches, which were managed with endovascular deconstructive exclusion and subsequent MMAe. One patient with chronic anemia underwent isolated MMAe. Among all patients, 5 (26.3%) were on anticoagulant/antiplatelet therapy, and hemodynamically significant carotid stenosis was identified in 3 patients (15.8%). Follow-up imaging (CT, MRI) at 6 months demonstrated clinical improvement in 100% of cases, with complete hematoma resolution in 17 patients (89.5%).
Conclusions: MMAe has proven to be highly effective and safe in the management of cSDH, both as a stand-alone method and as an adjunct to conventional surgery. The transradial approach demonstrated advantages in elderly and high-risk patients, contributing to reduced hospitalization times. Furthermore, the use of OnyxTM ensured deeper penetration and more durable occlusion of pathological vessels compared to polyvinyl alcohol (PVA) particles. These findings are consistent with current global trends and confirm the promising role of MMAe in cSDH treatment.
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