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Case series
Efficacy and mid-term outcome of middle meningeal artery embolization with or without burr hole evacuation for chronic subdural hematoma compared with burr hole evacuation alone
  1. Christina Onyinzo1,
  2. Ansgar Berlis2,3,
  3. Maria Abel1,
  4. Manfred Kudernatsch1,4,
  5. Christoph J Maurer2,3
  1. 1 Department of Neurosurgery, Schoen Clinic Vogtareuth, Vogtareuth, Bavaria, Germany
  2. 2 Department of Diagnostic and Interventionell Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Bavaria, Germany
  3. 3 Department of Neuroradiology, Schoen Clinic Vogtareuth, Vogtareuth, Bavaria, Germany
  4. 4 Research Institute Rehabilitation, Transition, Palliation, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
  1. Correspondence to Christina Onyinzo, Neurosurgery, Schön Klinik Vogtareuth, Vogtareuth, Bavaria, Germany; ch.onyinzo{at}


Background Chronic subdural hematoma (CSDH) is a common neurosurgical condition with high recurrence rates. Repeated microbleedings from fragile neo-vessels supplied by peripheral branches of the middle meningeal artery (MMA) are believed to be responsible for the growth and recurrence of CSDH. Thus, MMA embolization might be a promising method to prevent re-bleedings and recurrences. This study aims to assess the efficacy, complication rates, and mid-term outcome of MMA embolization with or without burr hole irrigation compared with burr hole irrigation alone.

Methods Patients diagnosed with CSDH who underwent MMA embolization and/or surgical treatment were retrospectively recruited to this single-center study. The outcome variables were defined as treatment-related complications, clinical outcome at discharge, rate of revision surgery, and CT findings during the follow-up period.

Results A total of 132 patients with CSDH were included in the study. The use of antiplatelet/anticoagulant medication was significantly higher in the combined treatment and embolization group (p<0.001). A trend towards fewer revision surgeries was found in the group of patients who received MMA embolization combined with burr hole irrigation (p=0.083). Follow-up was available for 73 patients (55.3%) with a mean follow-up period of 3.4±2.2 months. Eight patients (15.1%) of the surgery group showed hematoma re-accumulation and needed surgical rescue, whereas only one patient (5.0%) of the combined treatment group needed revision surgery. In all patients treated with only MMA embolization, complete hematoma resolution was found.

Conclusion MMA embolization is a safe and efficacious minimal invasive adjuvant and/or alternative procedure for the treatment of CSDH with a reduced recurrence rate.

  • artery
  • complication
  • hemorrhage
  • subdural
  • liquid embolic material

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  • Contributors CO and CJM planned the article concept and design. AB and CJM performed the neurointerventional treatment (MMA embolization). MK, MA and CO were involved in the patients’ treatment, care and follow-up. The ethical proposal was written by MK and CO. CO wrote the manuscript with support from CJM. All authors discussed the results and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.