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Shotar E, Premat K, Lenck S, et al. Angiographic Anatomy of the Middle Meningeal Artery in Relation to Chronic Subdural Hematoma Embolization. Clin Neuroradiol. 2021;doi: 10.1007/s00062-021-00996-5.
Shotar, E., Premat, K., Lenck, S., Degos, V., Marijon, P., Pouvelle, A., Pouliquen, G., Mouyal, S., Abi Jaoude, S., Sourour, N. A., Mathon, B., & Clarençon, F. (2021). Angiographic Anatomy of the Middle Meningeal Artery in Relation to Chronic Subdural Hematoma Embolization. Clinical neuroradiology, . https://doi.org/10.1007/s00062-021-00996-5
Shotar, Eimad, et al. "Angiographic Anatomy of the Middle Meningeal Artery in Relation to Chronic Subdural Hematoma Embolization." Clinical neuroradiology vol. (2021). doi: https://doi.org/10.1007/s00062-021-00996-5
Shotar E, Premat K, Lenck S, Degos V, Marijon P, Pouvelle A, Pouliquen G, Mouyal S, Abi Jaoude S, Sourour NA, Mathon B, Clarençon F. Angiographic Anatomy of the Middle Meningeal Artery in Relation to Chronic Subdural Hematoma Embolization. Clin Neuroradiol. 2021 Feb 24; doi: 10.1007/s00062-021-00996-5. Epub 2021 Feb 24. PMID: 33625552.
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Clin Neuroradiol. 2021 Feb 24; doi: 10.1007/s00062-021-00996-5. Epub 2021 Feb 24.

Angiographic Anatomy of the Middle Meningeal Artery in Relation to Chronic Subdural Hematoma Embolization.

Clinical neuroradiology

Eimad Shotar, Kevin Premat, Stéphanie Lenck, Vincent Degos, Pauline Marijon, Arnaud Pouvelle, Geoffroy Pouliquen, Samuel Mouyal, Samiya Abi Jaoude, Nader-Antoine Sourour, Bertrand Mathon, Frédéric Clarençon

Affiliations

  1. Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. [email protected].
  2. Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
  3. Sorbonne Université, Paris, France.
  4. Department of Neurosurgical Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.
  5. Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France.

PMID: 33625552 DOI: 10.1007/s00062-021-00996-5

Abstract

PURPOSE: Middle meningeal artery (MMA) embolization is emerging as a potential treatment of chronic subdural hematomas (CSDHs). The purpose of this study is to describe MMA angiographic anatomy in relation to CSDH embolization.

METHODS: This retrospective monocentric study was performed on imaging data of MMA embolization procedures for CSDH treatment performed between March 15, 2018 and April 30, 2020. Imaging data, including digital subtraction angiography (DSA) were reviewed independently by two physicians. Discrepancies were resolved by consensus. The MMA bifurcation pattern was analyzed according to an extended Adachi classification. Relations of the MMA with the ophthalmic artery (OA) were also analyzed.

RESULTS: In this study, 140 MMAs were analyzed. Dominance of the anterior branch (type I) was observed in only 57/140 (41%) MMAs with a moderate interobserver agreement for classifying MMA into type I against all other (κ = 0.53, 95% confidence interval, CI 0.39-0.67). The posterior branch presented a proximal origin (type A), at the point of emergence of the MMA from the foramen spinosum or its immediate vicinity, in 48/135 (36%) MMAs with a very good interobserver agreement for classifying MMAs into type A against all other (κ = 0.82, 95% CI 0.72-0.92). An angiographic relationship with the OA was observed in 26 MMAs (19%).

CONCLUSION: In the majority of CSDH patients both anterior and posterior branches of the MMA should be targeted to achieve extensive convexity devascularization. Frequent anatomical variations of the MMA with respect to emergence of the posterior branch and MMA orbital branches are expected to impact CSDH embolization strategy.

Keywords: Anatomy; Chronic subdural hematoma; Dangerous anastomosis; Embolization; Middle meningeal artery

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