1166. Onyx Embolization of the Middle Meningeal Artery for Recurrent Chronic Subdural Hematoma: 2 Case Reports

Authors: Maureen Darwal, DO; Rebecca Houston; Mohammad Arshad; Kevin Zhao, DO; Anil Nair, MD; Ciro Randazzo, MD; Otakar Hubschmann, MD (Montclair, NJ)

Introduction: Recurrence rates following surgical treatment of symptomatic chronic subdural hematomas (SDHs) has been reported at over 30% and often requires intervention. Embolization of the middle meningeal artery (MMA) has been reported as an alternative in the treatment of chronic subdural hematomas by eliminating the blood supply to the neovascular membrane within the subdural space. While polyvinyl alcohol particles (PVA) have been used in the past, Onyx® LES could also be an effective agent. We report two cases of recurrent chronic SDHs treated with Onyx embolization of the MMA.

Methods: The criteria for intervention via MMA embolization was defined as a re-accumulation of subdural blood following surgical evacuation that was significant enough to cause clinical symptoms. During the intervention, a guide catheter was placed in the distal left external carotid artery via a femoral approach through which a microcatheter and microwire were used to access the left frontal branch of the MMA. Following injection of DMSO, 0.5 mL of Onyx 18 was slowly injected. The first procedure used a Scepter balloon assist technique while the second procedure used a plug and push technique. Both procedures were done at a single institution by the same pair of neurosurgeons.

Results: Onyx embolization of the left MMA was successfully performed in both patients without complications. Post-operative day one CT scans on both patient remained stable. One patient had improvement of word finding difficulties within 24 hours, and the other patient maintained a stable exam. Both patients were discharged home on post-operative day 1. 

Conclusion: Two patients successfully underwent Onyx embolization of the MMA for recurrent subdural hematomas. Follow up scans to monitor the regression of the SDH will be presented. These results suggest that Onyx can safely be used for the embolization of the MMA in treating recurrent chronic SDHs.