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

İplikçioğlu, Ahmet Celal MD

doi: 10.1093/neuros/nyaa216

To the Editor:

I read the article by Link et al1 with great interest. The authors treated 60 cases of chronic subdural hematoma with middle meningeal artery embolization. In 10 of these cases, the procedure was performed soon after the surgical evacuation; the authors called this profilactic embolization. In 2005, we conducted a study in which surgical clipping or ligation of middle meningeal artery was performed.2 In 14 cases of convexity chronic subdural hematoma treated with burr hole evacuation and closed-drainage, we also opened an additional burr hole according to the location of the middle meningeal groove detected on plain skull graphy and clipped or ligated the artery. A total of 13 cases from the control group were treated with burr hole evacuation and closed-drainage system only. Average drainage duration, total drainage volume and total protein albumin and global levels in the drained material were all lower in middle meningeal artery clipping group than those of control group. However, the results were not statistically significant, probably because of the low number of participants. We think that intraoperative clipping of the middle meningeal artery in surgical cases could be a cost-effective alternative to prophylactic embolization.


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


1. 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.
2. Bikmaz K, Iplikçioğlu C, Dinc C, Arslan M. Treatment of chronic subdural hematomas by clipping of arteria meningia media. Skull Base. 2006;16(1):A024 (doi:10.1055/s-2006-958291).
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