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Iran J Neurosurg 2025, 11 - Continuous Publishing: 0-0 |
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Fahim F, Mehmandoost M, Abbasi H, Sharifzadeh S, Bahri A M, Oveisi S. Middle Meningeal Artery Embolization in Septated Chronic Subdural Hematoma: A Narrative Review of Mechanisms, Outcomes, and Unmet Needs. Iran J Neurosurg 2025; 11
URL: http://irjns.org/article-1-495-en.html
URL: http://irjns.org/article-1-495-en.html
Farzan Fahim *1 
, Mahdi Mehmandoost2 , Hesan Abbasi2 , Shahrzad Sharifzadeh1 , Amir Mohammad Bahri1 , Sayeh Oveisi1
, Mahdi Mehmandoost2 , Hesan Abbasi2 , Shahrzad Sharifzadeh1 , Amir Mohammad Bahri1 , Sayeh Oveisi1
1- Functional Neurosurgery Research Center, Research Institute of Functional Neurosurgery, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract: (7 Views)
Background and Aim: Chronic subdural hematoma (cSDH), particularly its septated subtype (sCSDH), poses significant therapeutic challenges due to its propensity for recurrence and resistance to conventional surgical interventions. Septated cSDH is characterized by fibrin membranes that compartmentalize the hematoma, impeding complete drainage and perpetuating inflammationdriven neovascularization. Current management strategies including burr-hole craniostomy (BHC), craniotomy, and pharmacotherapy exhibit recurrence rates of 20–30% in septated cases, underscoring the need for alternative approaches.
Methods and Materials/Patients: A targeted narrative review was conducted by searching PubMed, Scopus, and Web of Science (January 2000–July 2025) and peer-reviewed human studies meeting predefined inclusion criteria were reviewed. This review synthesizes existing literature to evaluate MMAE’s efficacy in septated cSDH. Results: Key findings highlight MMAE’s ability to reduce recurrence rates (3.1% vs 23.4% in nonembolized septated cases) when used adjunctively with surgery or as monotherapy, particularly in high-risk or recurrent patients. Technical considerations, such as transradial access (TRA) and embolic agent selection (e.g. polyvinyl alcohol, gelatin sponge), further enhance procedural safety and outcomes. Emerging evidence supports MMAE’s role in disrupting the angiogenicinflammatory cycle unique to septated cSDH, offering a paradigm shift in management.
Conclusion: Despite promising results, challenges persist, including the need for specialized expertise and limited long-term data. However, prospective randomized trials are warranted to optimize protocols and solidify its position in clinical guidelines. This review underscores MMAE as a transformative adjunctive strategy for septated cSDH, bridging gaps in traditional therapies while advocating for further research to refine its application.
Methods and Materials/Patients: A targeted narrative review was conducted by searching PubMed, Scopus, and Web of Science (January 2000–July 2025) and peer-reviewed human studies meeting predefined inclusion criteria were reviewed. This review synthesizes existing literature to evaluate MMAE’s efficacy in septated cSDH. Results: Key findings highlight MMAE’s ability to reduce recurrence rates (3.1% vs 23.4% in nonembolized septated cases) when used adjunctively with surgery or as monotherapy, particularly in high-risk or recurrent patients. Technical considerations, such as transradial access (TRA) and embolic agent selection (e.g. polyvinyl alcohol, gelatin sponge), further enhance procedural safety and outcomes. Emerging evidence supports MMAE’s role in disrupting the angiogenicinflammatory cycle unique to septated cSDH, offering a paradigm shift in management.
Conclusion: Despite promising results, challenges persist, including the need for specialized expertise and limited long-term data. However, prospective randomized trials are warranted to optimize protocols and solidify its position in clinical guidelines. This review underscores MMAE as a transformative adjunctive strategy for septated cSDH, bridging gaps in traditional therapies while advocating for further research to refine its application.
Keywords: Chronic subdural hematoma, Septated cSDH, Middle meningeal artery embolization (MMAE), Recurrence, Neovascularization, Minimally invasive therapy
Type of Study: Review |
Subject:
Endovascular Neurosurgery
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This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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