BackgroundEndovascular embolization of the middle meningeal artery (MMA) has emerged as an adjunctive and stand-alone modality for the management of chronic subdural hematomas (cSDH). We report our experience utilizing proximal MMA coil embolization to augment cSDH devascularization in MMA embolization.MethodsMMA embolization cases with adjunctive proximal MMA coiling were retrospectively identified from a prospectively maintained IRB-approved database of the senior authors.ResultsOf the 137 cases, all patients (n = 89, 100%) were symptomatic and underwent an MMA embolization procedure for cSDH. 50 of the patients underwent bilateral embolizations, with 53% (n = 72) for left-sided and 47% (n = 65) for right-sided cSDH. The anterior MMA branch was embolized in 19 (14%), posterior in 16 (12%), and both in 102 (74.5%) cases. Penetration of the liquid embolic to the contralateral MMA or into the falx was present in 38 (28%) and 31 (23%) cases, respectively, and 46 (34%) cases had ophthalmic or petrous collateral (n = 41, 30%) branches. MMA branches coiled include the primary trunk (25.5%, n = 35), primary and anterior or posterior MMA trunks (20%, n = 28), or primary with the anterior and posterior trunks (54%, n = 74). A mild ipsilateral facial nerve palsy was reported, which remained stable at discharge and follow-up. Absence of anterograde flow in the MMA occurred in 137 (100%) cases, and no cases required periprocedural rescue surgery for cSDH evacuation. The average follow-up length was 170 ± 17.9 days, cSDH was reduced by 4.24 ± 0.5(mm) and the midline shift by 1.46 ± 0.27(mm). Complete resolution was achieved in 63 (46.0%) cases.ConclusionProximal MMA coil embolization is a safe technique for providing additional embolization/occlusion of the MMA in cSDH embolization procedures. Further studies are needed to evaluate the potential added efficacy of this technique.

中文翻译：

---

辅助近端弹簧圈闭塞治疗慢性硬膜下血肿脑膜中动脉栓塞术的即时手术安全性：137例经验

背景脑膜中动脉（MMA）血管内栓塞已成为治疗慢性硬膜下血肿（cSDH）的辅助和独立方式。我们报告了我们在 MMA 栓塞中利用近端 MMA 弹簧圈栓塞来增强 cSDH 断流的经验。方法从前瞻性维护的 IRB 批准的高级作者数据库中回顾性鉴定了辅助近端 MMA 弹簧圈的 MMA 栓塞病例。结果 在 137 例病例中，所有患者（n = 89, 100%) 有症状并接受了 cSDH 的 MMA 栓塞手术。其中 50 名患者接受了双侧栓塞，其中 53% (n = 72) 为左侧 cSDH，47% (n = 65) 为右侧 cSDH。MMA 前支栓塞 19 例（14%），后支栓塞 16 例（12%），两者均有 102 例（74.5%）。液体栓塞渗入对侧 MMA 或大脑镰的情况分别为 38 (28%) 和 31 (23%) 例，46 (34%) 例有眼部或岩部侧枝循环（n = 41, 30%） ) 分支机构。盘绕的 MMA 分支包括主干 (25.5%，n = 35)、主干和前或后 MMA 干 (20%，n = 28)，或主干和前干和后干 (54%，n = 74)。据报道有轻度同侧面神经麻痹，出院和随访时保持稳定。137 例 (100%) 例发生 MMA 中缺乏顺行血流，并且没有病例需要围手术期救援手术进行 cSDH 清除。平均随访时间为170±17.9天，cSDH减少4.24±0.5(mm)，中线移位1.46±0.27(mm)。63 例 (46.0%) 病例获得完全缓解。 结论 近端 MMA 弹簧圈栓塞是一种安全的技术，可在 cSDH 栓塞手术中提供额外的 MMA 栓塞/闭塞。需要进一步的研究来评估该技术的潜在附加功效。