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CORRESPONDENCE

In Reply: Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Series of 60 Cases

Link, Thomas W MD, MS; Knopman, Jared MD

doi: 10.1093/neuros/nyaa219
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To the Editor:

Thank you for your comments.1,2 Surgical ligation of the middle meningeal artery (MMA) at the time of hematoma evacuation would provide stump embolization of the proximal MMA. Potential limitations of this technique compared to endovascular embolization include lack of embolization of the distal arterioles and lack of access to the entire MMA vasculature (ie, one would only ligate the branch that is surgically accessible). This could theoretically result in less complete embolization, as we believe it is necessary to penetrate the distal small arterioles to address the primary source of the pathology, which is the leaky distal neovasculature. Ligation of the artery would also eliminate the access for embolization in the future. For these reasons, we believe that surgical ligation is not a satisfactory alternative to embolization.

Disclosures

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

REFERENCES

1. Zheng F, Qiu C, Zou L, Yang S, Krischek B. Letter: middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases. Neurosurgery. 2019;85(2):E392.
2. Link TW, Boddu S, Paine SM, Kamel H, Knopman J. Middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases. Neurosurgery. 2019;85(6):801-807.
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