Introduction: Small acute epidural hematomas (EDHs) treated conservatively carry a nonmeasurable risk of late enlargement due to middle meningeal artery (MMA) lesions. Patients with EDHs need to stay hospitalized for several days, with neurological supervision and repeated CT scans. In this study, the authors analyzed the safety and efficacy of the embolization of the involved MMA and associated lesions.

Methods: The study group consisted of 80 consecutive patients harboring small- to medium-sized EDHs treated by MMA embolization between January 2010 and December 2014. A literature review cohort was used as a control group.

Results: The causes of head injury were falls, traffic-related accidents (including car, motorcycle, and pedestrian vs. vehicle accidents), and assaults. The EDH topography was mainly temporal (lateral or pole). Active contrast leaking from the MMA was seen in 57.5%; arteriovenous fistulas between the MMA and diploic veins were observed in 10%, and MMA pseudoaneurysms were found in 13.6% of the cases. Embolizations were performed under local anesthesia in 80% of the cases, with N-butyl-2-cyanoacrylate, polyvinyl alcohol particles, or gelatin sponge (or a combination of these), obtaining MMA occlusion and complete resolution of the vascular lesions. All patients underwent follow-up CT scans between 1 and 7 days after the embolization. In the 80 cases in this series, no increase in the size of the EDH was observed, and the clinical evolution was uneventful, without Glasgow Coma Scale score modification after embolization and with no need for surgical evacuation. In contrast, the control cohort from the literature consisted of 471 patients, 82 (17.4%) of whom shifted from conservative treatment to surgical evacuation.

Conclusions: This study suggests that MMA embolization is a highly effective and safe method to achieve size stabilization in nonsurgically treated acute EDHs.

Patient Care: We demonstrate noninvasive alternatives for the management of traumatic epidural hematomas

Learning Objectives: Identify therapeutic alternatives to treatment of epidural hematomas

References: Peres CM, Caldas JG, Puglia P Jr, de Andrade AF, da Silva IA, Teixeira MJ, Figueiredo EG. Endovascular management of acute epidural hematomas: clinical experience with 80 cases. J Neurosurg. 2017 Apr 14:1-7. doi: 10.3171/2016.11.JNS161398. [Epub ahead of print] PubMed PMID: 28409733.