Middle meningeal artery embolization and subdural evacuating port system placement for chronic subdural hematomas: how I do it.

Abstract

Chronic subdural hematoma (cSDH) is a common neurosurgical pathology causing significant morbidity and mortality, yet optimal management and intervention remains controversial. We describe embolization of the middle meningeal artery (MMA) and placement of subdural evacuating port systems (SEPS) by a dual trained open and endovascular neurosurgeon. Both procedures are done in sequence in the interventional radiology suite, and real time radiographic results are demonstrable with Xper-CT. MMA Embolization followed by evacuation of cSDH with a SEPS is a valuable strategy to mitigate perioperative risk factors and patient comorbidities, through a minimally invasive evacuation with subsequent embolization minimizing recurrence.