Middle Meningeal Artery (MMA) Embolization: A Complete Guide
Middle Meningeal Artery (MMA) Embolization: A Complete Guide
Head injury and certain neurological conditions can sometimes lead to chronic subdural hematoma, which is a slow, silent bleeding around the brain, in simple words. Until recently, surgery was the only way to treat such conditions. But today, medical advancements have introduced less invasive treatment options that can achieve the same result with a faster recovery time. One such procedure is Middle Meningeal Artery (MMA) Embolisation.
Even though the name may sound complicated, the procedure is minimally invasive and relatively simpler than the surgery. In this guide, let’s understand what MMA embolization is, why this technique is becoming increasingly popular, when it is recommended, how it is performed, and what patients can expect during recovery.
What Is Middle Meningeal Artery (MMA) Embolization?
To better understand this treatment method, let’s look at the problem it solves. A subdural hematoma is a collection of blood that slowly builds up between the brain and its outer covering(medically called dura). It usually happens after a head injury and is more common in older adults. People taking blood-thinning medicines and patients with brain shrinkage due to aging are also more prone to such a condition. Over time, this blood can keep re-accumulating even after a successful surgery. This causes persistent headaches, confusion/memory problems, weakness on one side of the body, difficulty walking, or drowsiness.
Middle meningeal artery is one of the blood vessels that supplies the outer covering of the brain (the dura). We need to block this vessel in order to prevent the further accumulation of blood in the dura. MMA embolization does exactly that. It is a procedure where doctors block the middle meningeal artery and stop the blood flow that keeps feeding the hematoma.
What does the procedure look like?
It’s performed by an interventional neurologists or neurointerventionalist. It is a minimally invasive procedure, meaning it doesn’t require opening the skull. During the process, the patient receives local anaesthesia and mild sedation.
A thin catheter is inserted into an artery, usually through a small puncture on the groin. It is then guided to the middle meningeal artery using advanced imaging and real-time X-ray. Then, tiny embolic particles or special medical adhesives are injected to block the artery. So that it stops the blood flow to the abnormal blood vessels that contribute to persistent bleeding.
After successfully completing the procedure, the catheter is removed and the tiny puncture site will be closed. No cuts, no stitches and no incisions on the head.
Depending on the patient’s condition, the entire procedure generally takes around one to two hours.
Who is eligible for this procedure?
We neurologists do not recommend MMA for everyone with a subdural hematoma.
We carefully evaluate patient and suggest MMA based on several factors, such as
- Size of the hematoma
- Severity of symptoms
- Patient's age
- Overall medical condition
- History of previous hematoma recurrence
- Use of blood-thinning medications
Benefits of MMA
MMA embolization offers a few real advantages, like
- Minimally invasive - Instead of large incisions, MMA embolization only needs small puncture. No cutting into the skull or stitching. Also this procedure reduces the surgical trauma.
- Lower recurrence rate -MMA embolization tackles the root cause. Blocking the blood supply responsible for continued bleeding, significantly reduces the likelihood of chronic subdural hematoma returning.
- Faster recovery with shorter hospital stay -This treatment relatively takes less time to operate than the open surgery. Most patients can return home within 24 to 48 hours. Also, depending on their condition, most of them can resume their daily activities sooner than that of the surgery.
- Suitable for high risk patients -This is often the best option for older adults or patients who are not able to tolerate conventional brain surgery, as it is less invasive.
- Can be combined with surgery - For patients with large hematomas causing significant pressure on the brain, MMA embolization may be performed after surgical drainage to reduce the chances of recurrence.
What does recovery look like?
Recovery after MMA embolization is generally smooth and quick. Most patients remain under observation for a day and may be discharged within 24 to 48 hours if no complications arise. Mild soreness at the catheter insertion site is common and usually resolves within a few days.
We may schedule follow-up brain scans over the next few weeks or months to confirm the hematoma is shrinking as expected.
Most people can resume light activities within a few days and normal routines within a couple of weeks.
Bottom line
MMA embolization offers a safe, effective, minimally invasive alternative to conventional surgery. It is transformed how the chronic subdural hematoma is treated.
If you or a loved one has been diagnosed with a chronic subdural hematoma, consult a qualified interventional neurologist or neurointerventional specialist to determine whether MMA embolization is a suitable treatment option. Early diagnosis and timely intervention can make a significant difference in recovery and overall brain health.
Authored by Dr. Safal Sachidananda Shetty, an Interventional Neurologist & Stroke Expert in Bangalore with extensive clinical experience in stroke intervention, brain aneurysms, and complex neurovascular disorders. His mission is to educate, prevent, and provide advanced neurologic care using the latest medical innovations and minimally invasive procedures.