Subdural Hematoma Embolization
Subdural Hematoma Embolization
A subdural hematoma is bleeding inside the subdural space (between the skull and brain). Until recently, most cases were either treated with surgery or monitored until they spontaneously resolved. But now, many patients can be treated with a less invasive and highly effective approach called subdural hematoma embolization. Vascular and Interventional Partners in Scottsdale, AZ is proud to offer this groundbreaking procedure to our patients.
What Is Subdural Hematoma Embolization?
Subdural hematoma embolization is a less invasive alternative to craniotomy or burr hole drainage for chronic subdural hematomas.
A subdural hematoma is bleeding between the skull and brain that usually occurs due to a head injury. It can be acute or chronic. Acute cases can be a medical emergency as the collection of blood within the subdural space can rapidly increase pressure on the brain. Chronic cases usually have a better prognosis but are complicated with a high recurrence rate.
A subdural hematoma embolization, also called middle meningeal arterial (MMA) embolization, is a minimally invasive procedure combining angiography, microcatheters and polyvinyl alcohol particles. The treatment blocks blood flow from meningeal arteries into the pathological structures in the brain’s membrane believed to be behind most chronic subdural hematomas.
Once the patient is treated, the hematoma resolves within six months with minimal risk of recurrence. Symptomatic cases, however, may need to be treated with a combination of subdural hematoma embolization and surgery.
Subdural Hematoma Embolization
As a novel and advanced procedure, subdural hematoma embolization comes with many benefits, including the following:
- Removes the need for surgery and general anesthesia
- Quick procedure and fast recovery times
- Suitable for older and critically ill patients
- Can be an outpatient procedure
- Low hematoma recurrence rates
Why Choose Vascular and Interventional Partners?
A subdural hematoma diagnosis can be frightening. But when treated by skilled professionals with the latest techniques, patients can rest assured that they will have the best outcomes.
The team of Arizona’s leading interventional radiologists at Vascular and Interventional Partners is experienced using minimally invasive techniques such as subdural hematoma embolization. We’ve treated countless patients with chronic subdural hematomas and seen their condition remarkably improve.
Frequently Asked Questions
How does subdural hematoma embolization compare to surgery?
Subdural hematoma embolization has become the standard of care for chronic subdural hematomas in all major medical centers in the country. That is because it has many advantages over surgery:
- Less invasive with faster recovery
- Can be performed on a wide range of patients
- Usually no need for general anesthesia
- No post-procedure scarring
- Few reported complications and side effects
- Prevents recurrence in chronic hematomas
Because the majority of patients with chronic subdural hematomas are over 60 years old and have significant medical comorbidities, a less invasive treatment option such as this is typically a safer choice.
How should I prepare for the procedure?
Before your procedure, we will order tests to check your kidney function and whether your blood clots normally. We will ask you about any medications and supplements you may be taking and adjust your dose if necessary. We will also ask whether you have any known allergies.
We will provide you with detailed instructions on how to prepare for your procedure. This may include ceasing intake of blood-thinning medication and supplements and fasting the day before your procedure.
If you are pregnant or if there is any chance you might be pregnant, it is important to let your doctor know because this procedure involves the use of x-rays that may harm the unborn baby.
It’s also a good idea to wear comfortable and loose-fitting clothing so you can easily change before and after your procedure. Make sure to arrange for someone to drive you back home. You may also need to take a couple of days off depending on the severity of your case.
What happens during the subdural hematoma embolization procedure?
For this procedure, you will be lying down on an operating table in an interventional radiology suite. The procedure can be performed under moderate sedation but is usually done with the patient under general anesthesia.
Once you are sedated, your interventional radiologist creates a small incision in your arm or leg to access a major blood vessel and advances a catheter through several main arteries using x-ray guidance. Your provider will try to reach the middle meningeal artery that supplies the dura mater, which is the outer membrane surrounding your brain and is often the source of bleeding in chronic subdural hematoma.
Once they have reached the site of the bleeding, your provider will release small particles or a liquid embolic agent that permanently blocks blood flow from the middle meningeal artery. They will then remove the catheters and close the incision site. The whole procedure should take 30 to 60 minutes, with additional time needed for preparation and signing of consent forms.
What are the risks of this procedure?
The risks associated with subdural hematoma embolization include:
- Allergic reactions to contrast material
- Post-procedure bleeding, bruising and infections
- Damage to nearby arteries
- Kidney damage from the contrast material
- Recurrence of the hematoma
What is the expected recovery after subdural hematoma embolization?
Immediately after your procedure, you will be taken to a recovery room where nurses will monitor your vitals and check for any abnormal bleeding. Some patients need to remain in the hospital overnight, but most can go home on the same day.
Minor pain and swelling at the incision site are normal post-treatment. You may also notice a mild but manageable headache in the days after your procedure. Keep your incision site clean as instructed and avoid strenuous activities in the first few days. Make sure to get plenty of rest and sleep and return to your usual activities slowly.
The procedure should lead to a reduction and eventual cessation of the chronic bleeding over several weeks post-treatment. As your recovery continues, the hematoma should spontaneously resolve after a couple of months. Full recovery will be confirmed with a CT or MRI scan.