A subdural hematoma is an unsettling diagnosis, especially when you learn that a collection of blood around the brain can become chronic. If you or someone you love has been diagnosed with one, you may also be hearing about a newer minimally invasive option called middle meningeal artery embolization, or MMA embolization. For some, this neuroendovascular procedure can target blood vessels that contribute to the persistence and recurrence of a chronic subdural hematoma. Research finds that patients who received MMA embolization in addition to standard treatment have a lower rate of treatment failure at 180 days than those who received standard treatment alone.
Continue reading to learn more about how MMA embolization works, who is a good candidate for this treatment, and where to find the best brain surgeon in Los Angeles.
How Does an MMA Embolization Treat a Subdural Hematoma?
Middle meningeal artery embolization is a minimally invasive procedure that uses a catheter to deliver an embolic material into the middle meningeal artery, which supplies blood to the membrane surrounding a chronic subdural hematoma. By reducing blood flow through these abnormal vessels, the procedure can help limit continued bleeding and reduce the risk of the hematoma growing or returning.
MMA embolization can be used as an adjunct to surgical drainage or, in selected patients, as part of a nonsurgical treatment strategy. The right approach depends on the hematoma's size and characteristics, symptoms, imaging findings, and overall health.
How Do Chronic Subdural Hematomas Form?
A chronic subdural hematoma is a collection of blood between the brain's outer protective covering, called the dura, and the surface of the brain. It can develop gradually after a head injury, sometimes after an injury that seemed minor at the time.
Older adults are particularly susceptible because the brain naturally becomes smaller with age, creating more space for movement within the skull. Blood-thinning medications, which are more commonly prescribed to older folks, can also increase the risk of bleeding.
Symptoms of a subdural hematoma can develop slowly over days or weeks and have a serious impact on quality of life. Symptoms may include:
- Headaches
- Confusion or changes in thinking
- Memory problems
- Balance or walking difficulties
- Weakness or numbness
- Speech changes
- Personality or behavior changes
- Increasing sleepiness
A chronic subdural hematoma can sometimes be mistaken for dementia symptoms or other neurological conditions. This is why new neurological symptoms, especially after a fall or head injury, always deserve medical evaluation.
How Does Middle Meningeal Artery (MMA) Embolization Work?
MMA embolization is a surgical treatment that reduces blood flow to the abnormal membrane surrounding the chronic subdural hematoma. The procedure requires a neuroendovascular specialist to guide a thin catheter through an artery, usually beginning at the wrist or groin. Using real-time X-ray imaging, the catheter is carefully navigated through the blood vessels toward the middle meningeal artery.
Once the appropriate branches are identified, the catheter delivers embolic material that blocks targeted blood vessels, reducing blood flow to the membrane associated with the hematoma. Over time, reduced blood flow can help the hematoma gradually resolve.
Is MMA Embolization the Right Treatment for Me?
MMA embolization is best for patients with symptomatic chronic or subacute subdural hematomas. Some situations when MMA embolization may be recommended include:
- A chronic subdural hematoma that has returned after previous treatment
- A patient at elevated risk for recurrence
- A hematoma being treated with surgical drainage
- A patient for whom a minimally invasive endovascular approach is appropriate
- Patients whose symptoms and imaging findings allow for a nonsurgical treatment strategy
This procedure is not suitable for every subdural hematoma. The treatment decision should always consider the hematoma's size, location, age, and appearance on imaging; the patient's symptoms, medications, medical history, and whether they have had prior treatment.
Recovery After MMA Embolization
Recovery time after an MMA embolization depends heavily on why the procedure was performed and whether it was combined with another brain surgery treatment.
Some patients undergo MMA embolization as an adjunct to surgical drainage. In that case, recovery depends on both procedures and the severity of the original hematoma. Other carefully selected patients may undergo embolization as part of a nonsurgical treatment strategy.
Patients should understand that embolization does not make the existing hematoma disappear immediately. The body needs time to gradually resorb the blood collection after reducing its vascular supply. This is why follow-up appointments are so important. Follow-up may include:
- Neurological examinations
- CT or other brain imaging
- Medication review
- Monitoring for recurrent symptoms
- Gradual return to normal activities
- Physical therapy referral
Any new or worsening weakness, confusion, severe headache, difficulty speaking, seizure, or significant change in alertness warrants immediate medical attention.
Finding the Best Middle Meningeal Artery Embolization Surgeon in Los Angeles
Dr. Parham Yashar is a board-certified, fellowship-trained neurosurgeon with residency training in neurological surgery at LAC+USC Medical Center/Keck School of Medicine and an Endovascular Neurosurgery Fellowship at the University at Buffalo, where he trained under Drs. L. Nelson Hopkins, Elad I. Levy, and Adnan H. Siddiqui.
For patients in Southern California looking for the best MMA embolization surgeon in Los Angeles, this combination of surgical and endovascular training ensures accurate diagnosis and advanced treatment options. Our patient-first approach starts with reviewing imaging and discussing whether middle meningeal artery embolization is appropriate, then developing a plan focused on protecting neurological function and supporting recovery.
Ready to trust the best brain surgeon in Los Angeles with your MMA embolization procedure?
