Middle meningeal artery embolization using cone-beam computed tomography augmented guidance in patients with cancer

Middle meningeal artery (MMA) embolization (MMAE) has recently emerged as a potential treatment of patients with meningioma and those with chronic or postoperative subdural hematoma (SDH) [1], [2], [3]. MMAE involves blocking the blood supply to the MMA, which is the main blood vessel that supplies blood to the dura, the outermost protective layer of the brain and spinal cord [4]. Several studies have demonstrated significantly greater degrees of tumor devascularization or improved rates of SDH resolution and decreased recurrence after MMAE compared with surgical evacuation [5,6]. MMAE may be an ideal solution in patients with cancer to avoid the risks of surgery and minimize adverse events [4,6]. Cone beam computed tomography (CBCT) allows intraprocedural three-dimensional (3D) imaging, enabling accurate anatomy identification, procedure planning and augmented fluoroscopy guidance [7], [8], [9]. These advantages might improve the precision and safety of neuro interventions, such as MMAE [10], [11], [12], [13]. Additionally, the use of CBCT can help reduce the radiation dose given to the patients compared to conventional computed tomography (CT) [14].

The purpose of this study was to investigate whether MMAE, when performed under CBCT guidance, can be an effective treatment option for patients with underlying cancer presenting with meningeal tumors, chronic or postoperative SDH.

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