Adjunct Surgical Middle Meningeal Artery Obliteration for Recurrent Chronic Subdural Hematoma: Case Series and Technical Note
Year: 2025
Type: article
Study design: Case Report
Abstract: BACKGROUND AND OBJECTIVES: Recurrence after surgical treatment of chronic subdural hematoma (CSH) remains a clinical challenge. Endovascular occlusion of the middle meningeal artery (MMA) through embolization has emerged as an adjunctive procedure to reduce recurrence. We present a case series in which we performed navigated surgical obliteration of the MMA (soMMA) through a third burr hole as an alternative treatment. METHODS: In line with the Preferred Reporting of Case Series in Surgery guidelines for surgical case series, we retrospectively analyzed 4 patients with symptomatic recurrent CSH, who received for revision an additional navigated pterional burr hole for soMMA. We report the surgical anatomy, technical considerations, clinical outcomes and potential indications. RESULTS: All patients were male, multimorbid, with a mean age of 83 years, and presented with recurrent symptomatic unilateral or bilateral CSH. Revision with adjunct soMMA was performed between 10 and 90 days after index surgery. soMMA was safe, easily integrated into the workflow, and no further recurrences occurred. All patients regained full function and remained asymptomatic at last follow-up. CONCLUSION: Navigated adjunct soMMA through a pterional burr hole is a viable and cost-effective option for the management of recurrent CSH. This technique may be especially valuable for patients with contraindications for endovascular MMA embolization and for centers lacking endovascular resources.
Source: Operative Neurosurgery
Institutions: University of Bern, University Hospital of Bern
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4415030746