Treatment for chronic subdural hematoma used to mean drilling in the skull, hospital stays, and a long recovery. Today, there is an effective, minimally invasive treatment available from the best neurosurgeon in Los Angeles.
A minor bump to the head may not seem significant when it happens, especially if no symptoms present themselves right away, but for older individuals, a subdural hematoma can develop weeks or even months later. Caused by a slow buildup of blood between the brain and its outer covering, a chronic subdural hematoma (cSDH) ranks among the most common neurosurgical conditions in older adults.
For decades, the standard fix for this condition meant drilling burr holes into the skull or removing a larger section of bone in a craniotomy. Modern brain surgery takes a different approach with minimally invasive middle meningeal artery (MMA) embolization. And many patients have it done as an outpatient procedure with light sedation.
Read on to learn how MMA embolization is performed, the risks and benefits of choosing this treatment, and where to find the best brain surgeon in Los Angeles for subdural hematoma treatment.
The middle meningeal artery sits just inside the skull and feeds the thin membranes that cover the brain. When those membranes tear and leak after a head bump or fall, blood pools in the space above the brain and slowly forms a chronic subdural hematoma. MMA embolization is a type of brain surgery that shuts off that leaking blood supply by threading a thin catheter through a wrist or groin artery, guiding it up to the middle meningeal artery, and releasing tiny particles that block the flow.
With the source cut off, the body reabsorbs the trapped blood over the following weeks to months. The best neurosurgeon in Los Angeles often recommends the procedure for patients who:
Before MMA embolization, the treatment for such conditions included burr-hole drainage involving drilling holes in the skull, or a craniotomy that removes a section of bone to scoop the clot out. MMA embolization works through one small artery puncture instead.
Preparation for MMA embolization usually starts a week or two before the procedure with imaging and lab work. You can expect a CT scan or MRI to measure the hematoma, blood tests to check kidney function and clotting, and a short visit with your surgeon and the anesthesia team to go over your medical history.
The medication review is an important step, because some medications can increase your risks of bleeding. Even herbal products like fish oil or ginkgo can affect bleeding. Bring a written list of everything you take, including over-the-counter drugs, vitamins, and supplements, because some blood thinners like warfarin, apixaban, and clopidogrel. It’s important to understand that you should not stop any medications on your own without instructions from your doctor.
The night before the procedure, you will need to stop eating around midnight and to limit fluids to small sips of water in the hours leading up to your arrival. Other ways you can prepare for a smooth surgery are to: Wear loose clothes, leave jewelry at home, and arrange a ride for after the procedure.
On the day of the procedure, you will change into a gown, have an IV placed, and meet your surgical team. After cleaning your wrist or groin and numbing the skin with a local anesthetic, the best brain surgeon in Los Angeles makes a small nick and slides a thin catheter into the artery. Using live X-ray images and a small amount of contrast dye, the catheter is guided up through the blood vessels until it reaches the middle meningeal artery on the side of your head. You may feel a brief warm flush when the dye goes in, but the catheter itself is painless because blood vessels have no pain sensors inside them.
Once the catheter is in position, the surgeon injects tiny particles, usually polyvinyl alcohol or microspheres about the width of a human hair, to block the artery. The catheter then comes out, the team applies pressure or places a small closure device at the entry site, and you are moved to recovery. The whole procedure usually takes one to three hours, and most patients stay awake under light sedation rather than fully asleep.
Like any procedure that involves the brain and blood vessels, MMA embolization carries real risks, but most are uncommon, and most patients do well. The most common side effects are usually related to the catheter entry site, and include things like soreness, a small bruise, or a quarter-sized lump that fades over a week or two.
A mild headache or some grogginess from sedation is also normal for the first day. The more serious risks are rare, but include stroke from a small clot or particle reaching the wrong vessel, temporary or lasting vision changes if embolic material drifts toward a branch that supplies the eye, infection at the puncture site, and bleeding inside the skull.
The contrast dye used during imaging also has rare risks. You should tell your team if you have kidney problems, a past allergic reaction to contrast, or a known iodine or shellfish sensitivity. There are ways to lower the risk of a reaction if any of these are true for you.
Right after the procedure, you will spend a few hours in a recovery area while a nurse checks your blood pressure, watches the puncture site, and asks you to wiggle your fingers or toes to confirm everything feels normal. If the catheter went in through your wrist, you can usually sit up and walk within an hour or two. Groin access usually requires you to lie flat for several hours so the artery can seal properly.
Most patients go home the same day or the following morning. For the first one to two weeks at home, you will be asked to skip heavy lifting, hot tubs, swimming, and strenuous exercise. Short walks and normal household activity are fine. Keep the entry site clean and dry, watch for swelling, redness, or a growing bruise, and call your doctor right away if you notice a sudden severe headache, new weakness on one side of the body, slurred speech, blurry vision, or a fever.
Typically, you will have a follow-up CT scan, often around six to 12 weeks after surgery, to confirm the hematoma is shrinking. Your surgical team will also tell you when it is safe to restart any blood thinners you paused before the procedure.
Recent randomized trials and meta-analyses show that adding MMA embolization to standard care cuts hematoma recurrence significantly compared with surgery or watchful waiting alone, and recurrence rates fall into the low single digits when you choose the best brain surgeon in Los Angeles for your treatment.
A chronic subdural hematoma diagnosis can feel scary, especially when this condition used to require open, invasive brain surgery. MMA embolization has changed this, replacing long hospital stays and large incisions with a single small puncture at the wrist and, in many cases, a same-day trip home.
Dr. Yashar is the surgeon Southern California families come to for the best subdural hematoma treatment in Los Angeles and a neurosurgeon who performs MMA embolization regularly.
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