Incidence of Cranial Neuropathy in Middle Meningeal Artery Embolization with Coils

Introduction: Embolization of the middle meningeal artery (MMA) for the treatment of chronic subdural hematoma (cSDH) has been demonstrated to be safe and effective leading to hematoma resolution. Embolization of the MMA is performed using polyvinyl alcohol (PVA) particles, liquid embolisate (cyanoacrylate, ONYX), coils, or a combination of modalities. MMA embolization with PVA particles poses the risk of particle reflux to the internal carotid artery or passage through extracranial-intracranial anastomoses, while ONYX poses the risk of migration due to its prolonged solidification time. Off-target embolization with PVA due to reflux of particles or migration of ONYX yields cranial nerve complications, mainly facial nerve palsy. Embolization of MMA using coils alone may eliminate the risk of cranial neuropathy. Our goal is to determine the incidence of facial nerve palsy within our institution’s cohort of subdural hematomas treated with middle meningeal artery embolization with coils as the sole embolisate.

Methods: Postoperative MMA embolization complications were retrospectively reviewed for the onset of cranial neuropathy following treatment. All patients had either acute or chronic subdural hematoma treated with coils.

Results: 37 patients with chronic subdural hematoma treated with MMA coil embolization of were identified. In this cohort, zero patients were found to have new onset cranial neuropathy following MMA embolization.

Conclusion : MMA embolization with usage of coils exclusively may reduce the chance of cranial neuropathy as a complication. Due to the low incidence of cranial neuropathy, more data is needed to determine the incidence of this complication with coil-only embolization.