Larger Middle Meningeal Arteries on Computed Tomography Angiography in Patients with Chronic Subdural Hematomas as Compared with Matched Controls

Abstract

Chronic subdural hematomas (CSDHs) are one of the most prevalent head-trauma-related conditions. The middle meningeal artery (MMA) may participate in the pathophysiology of CSDHs. The aim of this study was to determine whether CSDHs are associated with large MMAs. Patients referred for CSDH embolization and having undergone a computed tomography angiography (CTA) before embolization were retrospectively included. For each CSDH patient, two age- and sex-matched controls with a CTA performed during the study period were selected. Size comparisons of the MMA were performed between MMAs ipsilateral to CSDHs, on the contralateral side, and in controls. Comparison was also made with angiographic measurements from CSDH embolization procedures. Seventy-five patients with CSDH with available CTAs prior to embolization were enrolled and 146 MMAs were measured. One hundred fifty controls were included and 288 MMAs were measured. The median diameter of the 94 MMAs ipsilateral to a CSDH (1.5 mm; interquartile range [IQR] 1.3–1.7) was significantly larger than that of control MMAs (1.28 mm; IQR 1.15–1.4) (p < 0.001). The median diameter of 52 MMAs on the side of a unilateral CSDH (1.6 mm; IQR 1.4–1.8) was larger than that of the 52 contralateral MMAs (1.4 mm; IQR 1.25–1.6) (p < 0.001). Among the characteristics of patients with CSDH, multiple surgeries were associated with significantly larger MMAs (>1.7 mm; p = 0.01). MMAs ipsilateral to CSDHs appear to be significantly larger as compared with contralateral MMAs and MMAs in a control population, suggesting the involvement of the MMA in the pathophysiology of CSDH.