Craniometric Anatomy of the Middle Meningeal Artery Bifurcation With Relevance for Simultaneous Surgical Occlusion in Chronic Subdural Hematoma

作者：Aron Alakmeh, Daniel de Wilde, Flavio Vasella, Stefanos Voglis, Menno R. Germans, Luca Regli, Carlo Serra, Victor E. Staartjes · 发表于：Operative Neurosurgery · 年份：2026 · DOI：10.1227/ons.0000000000002094 · 被引用次数：1 · 研究领域：Neurosurgical Procedures and Complications、Traumatic Brain Injury and Neurovascular Disturbances、Meningioma and schwannoma management

BACKGROUND AND OBJECTIVES: Despite effective surgical evacuation, chronic subdural hematoma (cSDH) recurrence rates remain high. Middle meningeal artery (MMA) embolization has emerged as a promising adjunct significantly reducing recurrence rates but adding procedural risk, logistical complexity, and cost. Thus, single-stage cSDH evacuation with direct surgical MMA occlusion through a single pterional/frontotemporal burr hole could offer a practical alternative. This study assesses the applicability of this approach on routine preoperative imaging and evaluates both neuronavigation-guided and landmark-based localization of the MMA bifurcation. METHODS: In this single-center study, preoperative noncontrast cranial computed tomography scans of patients undergoing burr hole trepanation for cSDH were analyzed. We assessed osseous MMA anatomy, visibility, and dominance of the MMA bifurcation; its spatial relationship to the cSDH; and distances from 3 external craniometric landmarks [Stephanion, Bregma, and external auditory canal (EAC)-zygomatic root plane]. RESULTS: Twenty patients with 26 cSDHs were included. A distinct osseous groove indicating the MMA bifurcation was identifiable in all cases (100%). The bifurcation overlapped with the hematoma in 18/26 (75%) and projected onto the region of maximal thickness in 5/26 (21%). Mean craniocaudal and anteroposterior distances from the Stephanion to the bifurcation were 27.3 ± 12.3 mm and 8.8 ± 5.5 mm; from the Bregma 113.9 ± 18.2 m...