Middle meningeal artery (MMA) embolisation has emerged in the last two decades as a possible way to treat chronic subdural hematomas (CSDH). The outer layer of the hematoma capsule recruits blood supply from the dural arteries which will contribute through the leaky capillaries of the membrane to the expansion of the hematoma. Embolisation of these vessels can stop the process and push the equilibrium of fluid accumulation and regression toward the latter one. The practice of MMA embolisation is getting widespread and randomized studies are underway and even some positive results are already present. The most appropriate indications to supplement open surgery are still investigated.
We will present a special indication for this minimally invasive procedure in instances when the open surgical solution is extremely hazardous, like in patients with hematological malignancies having extreme and untreatable trombocytopenia and anaemia. Usually surgery is deffered in such cases and palliative care is introduced with the consequence of probable hematoma expansion and high mortality. However, minimally invasive MMA embolisation can be performed without additional risks. We treated two of such patients in the last 4 years and both of them had complete hematoma resoultion after one session of embolisation.
When open surgery is contraindicated due to coagulation disorders MMA embolisation is still a usefull tool against CSDHs.