Kronik Subdural Hematomda Orta Meningeal Arter Embolizasyonunun Etkinliği ve Güvenliği: Kanıta Dayalı Bir İnceleme

Year 2026, Volume: 43 Issue: 1 , 104 - 109 , 01.04.2026

Murat Yücel , Bülent Yıldız , Eyüp Çetin , Onur Çetin

https://izlik.org/JA72LK59JZ

Abstract

Kronik subdural hematom (KSDH), özellikle ileri yaş grubunda sık karşılaşılan ve genellikle minör travmalar sonrasında görülen bir intrakraniyal kanama türüdür. Kronik subdural hematom tedavisinde minimal invazif bir yaklaşım olan middle meningeal arter embolizasyonu, nüks oranlarını ve hastanede kalış süresini azaltması nedeniyle cerrahi tedaviye alternatif güvenli bir seçenektir.Bu makalede, KSDH’lu hastalarda minimal invaziv bir tedavi seçeneği olarak middle meningeal arter (MMA) embolizasyonu hakkında kapsamlı bir genel bakış açısı sunmayı amaçladık.

Keywords

Kronik subdural hematom , arteria meningea media embolizasyonu , cerrahi tedavi , konservatif , anjiyografi , embolizasyon

The efficacy and safety of middle meningeal artery embolization in chronic subdural hematoma: An evidence-based review

https://izlik.org/JA72LK59JZ

Abstract

Chronic subdural hematoma (CSDH) is a type of intracranial hemorrhage frequently encountered especially in the elderly age group and is usually seen after minor traumas. Middle meningeal artery embolization, which is a minimally invasive approach in the treatment of chronic subdural hematoma, is a safe alternative to surgical treatment because it reduces recurrence rates and length of hospital stay. In this article, we aim to present a comprehensive overview of middle meningeal artery (MMA) embolization as a minimally invasive treatment option for patients with CSDH.

Keywords

Chronic subdural hematoma , middle meningeal artery embolization , surgical treatment , conservative , angiography , embolization

References

• Yang W, Huang J. Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am.2017;28(2):205–210.
• Greenberg MS. Traumatic hemorrhagic conditions. In: Greenberg MS, editor. Handbook of Neurosurgery. 10th ed. New York: Thieme; 2023. p.1071–1092.
• Markwalder TM. Chronic subdural hematomas: a review. Neurosurgery. 1981;54:637–645.
• Toi H, Kinoshita K, Hirai S, et al. Present epidemiology of chronic subdural hematoma in Japan: analysis of 63,358 cases recorded in a national administrative database. J Neurosurg. 2018;128(1):222–228.
• Mühl-Benninghaus R. Middle meningeal artery embolization for treatment of chronic subdural hematoma. Radiologie (Heidelb). 2022;62(Suppl 1):17–21. doi:10.1007/s00117-022-01074-8.
• Ban SP, Hwang G, Byoun HS, et al. Middle meningeal artery embolization for chronic subdural hematoma. Radiology. 2018;286(3):992–999. doi:10.1148/radiol.2017170053.
• Ironside N, Nguyen C, Do Q, et al. Middle meningeal artery embolization for chronic subdural hematoma: a systematic review and meta-analysis. J Neurointerv Surg. 2021;13(10):951–957. doi:10.1136/neurintsurg-2021-017352.
• Bayar MA, İplikçioğlu AC, Kökeş F, Doğanay OS, Gökçek C. Kronik subdural hematomda olağandışı bilgisayarlı tomografi görünümü. Türk Nöroşirurji Dergisi. 1991;3:97–99.
• Iliescu IA. Current diagnosis and treatment of chronic subdural haematomas. J Med Life. 2015;8(3):278.
• Bonasia S, Smajda S, Ciccio G, Robert T. Middle meningeal artery: anatomy and variations. Am J Neuroradiol.2020;41(10):1777–1785. doi:10.3174/ajnr.A6739.
• Schmolling ÁH, Pérez-García C, Trejo C, López-Frías A, Jaroenngarmsamer T, Rosati S, Moreu M. Middle meningeal artery embolization for management of chronic subdural hematoma. Radiographics.2024;44(4):e230158.
• Güneş YC. Orta meningeal arter embolizasyonu. In: Bekçi T, editor. A’dan Z’ye Girişimsel Radyoloji. Ankara: Akademisyen; 2023. p.11–17.
• Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KL, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation.2017;14(1):108.
• Moshayedi P, Liebeskind DS. Middle meningeal artery embolization in chronic subdural hematoma: implications of pathophysiology in trial design. Front Neurol. 2020;11:923.
• Nia AM, Srinivasan VM, Lall RR, Kan P. Middle meningeal artery embolization for chronic subdural hematoma: a national database study of 191 patients in the United States. World Neurosurg. 2021;153:e300–e307.
• Tempaku A, Yamauchi S, Ikeda H, et al. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: five cases and a review of the literature. Interv Neuroradiol.2015;21:366– 371. doi:10.1177/1591019915583224.
• Bartek J, Biondi A, Bonhomme V, Castellan L, Catapano G, Cenzato M, Muto M. Multidisciplinary consensus-based statement on the current role of middle meningeal artery embolization (MMAE) in chronic subdural hematoma (cSDH). Brain Spine. 2024;4:104143.
• Shotar E, Mathon B, Rouchaud A, Mounayer C, Salle H, Bricout N, Clarençon F. Embolization of the middle meningeal artery for the prevention of chronic subdural hematoma recurrence in high-risk patients: a randomized controlled trial—the EMPROTECT study protocol. J Neurointerv Surg. 2025;17(e1):e172.
• Davies JM, Dlouhy K, Knopman J, Mokin M, Hassan AE, Harbaugh RE, et al. Adjunctive Middle Meningeal Artery Embolization for Subdural Hematoma. The New England journal of medicine. 2024;391(20):1890–900. doi: 10.1056/NEJMoa2313472.
• Sioutas GS, Vivanco-Suarez J, Shekhtman O, et al. Liquid embolic agents for middle meningeal artery embolization in chronic subdural hematoma: Institutional experience with systematic review and meta-analysis. Interv Neuroradiol. Published online June 15, 2023. doi:10.1177/15910199231183132.
• Fiorella D, Monteith SJ, Hanel R, et al. Embolization of the Middle Meningeal Artery for Chronic Subdural Hematoma. N Engl J Med. 2025;392(9):855-864. doi: 10.1056/NEJMoa2409845. Epub 2024 Nov 20.
• Salem MM, Kuybu O, Nguyen Hoang A, Baig AA, Khorasanizadeh M, Baker C, Burkhardt JK. Middle meningeal artery embolization for chronic subdural hematoma: predictors of clinical and radiographic failure from 636 embolizations. Radiology. 2023;307(4):e222045.
• Liebert A, Voit-Hohne H, Ritter L, et al. Embolization of the middle meningeal artery vs second surgery: treatment response and volume course of recurrent chronic subdural hematomas. Acta Neurochir (Wien). 2023;165(7):1967– 1974.
• Link TW, Boddu S, Paine SM, Kamel H, Knopman J. Middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases. Neurosurgery. 2019;85:801–807. doi:10.1093/neuros/nyy521.
• Waqas M, Vakhari K, Weimer PV, et al. Safety and effectiveness of embolization for chronic subdural hematoma: systematic review and case series. World Neurosurg. 2019;126:228–236. doi:10.1016/j.wneu.2019.02.208.
• Fiorella D, Arthur AS. Middle meningeal artery embolization for the management of chronic subdural hematoma. J Neurointerv Surg. 2019;11:912–915. doi:10.1136/neurintsurg-2019-014730.
• Rajah GB, Tso MK, Dossani R, Vakharia K, Siddiqui AH. Transradial embolization of the left middle meningeal artery and accessory middle meningeal artery for treatment of subacute-chronic subdural hematoma. J Neurointerv Surg. 2020;12:436. doi:10.1136/neurintsurg-2019-015493.
• Kan P, Maragkos GA, Srivatsan A, Srinivasan V, Johnson J, Burkhardt JK, Thomas AJ. Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations. Neurosurgery. 2021;88(2):268–277.
• Wali AR, Himstead A, Bravo J, Brandel MG, Hirshman BR, Pannell JS, Santiago-Dieppa DR. Helical coils augment embolization of the middle meningeal artery for treatment of chronic subdural hematoma: a technical note. J Cerebrovasc Endovasc Neurosurg. 2023;25(2):214–223.
• Catapano JS, Ducruet AF, Nguyen CL, et al. Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis. J Neurointerv Surg. 2021;13(7):657–660.
• Mohanty A, Mascitelli JR, Kan P. Middle meningeal embolization for subdural hematoma. In: Introduction to Vascular Neurosurgery. 2022. p.491–504.