Embolization of the Middle Meningeal Artery with ONYXTM Liquid Embolic System in the Treatment of Subacute and Chronic Subdural Hematoma Evacuation (EMBOLISE)

Chronic subdural hematoma (CSDH) is one of the most common diseases in neurosurgery. Though conventional surgical methods like burr-hole irrigation and craniotomy have been the mainstay of treatment, middle meningeal artery (MMA) embolization has recently emerged as a promising adjunctive or alternative treatment, especially in patients with intractable CSDH or in patients where anticoagulation or antiplatelet therapy cannot be stopped.

The MMA gives rise to capillary feeders of hematomas. Embolization of this artery is thought to inhibit blood flow into pathological structures, control bleeding from the CSDH membrane, and enhance spontaneous resolution of the hematoma, thus potentially providing a minimally invasive alternative or adjunct to conventional surgical techniques.

Chronic subdural hematoma (CSDH) occurs in approximately 14 patients per every 100,000 people and becomes more prevalent in older patients, with an occurrence of 18 patients per every 100,000 between the ages of 71-80. It is currently one of the most common diseases treated by neurosurgeons, and as the population ages, the incidence of CSDHs is expected to double in slightly over 25 years. There is significant morbidity and mortality associated with this common disease.

Recent studies have shown the efficacy of endovascular MMA embolization in treating CSDH. There is emerging data to suggest that this minimally invasive therapy may be more efficacious and equally as safe compared to conventional more invasive surgery. If these results can be supported by more vigorous clinical data, this represents a revolutionary change in the treatment of this common disease in the elderly with major morbidity and mortality.

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