Houston Methodist Sugar Land Hospital in Fort Bend County is using an innovative, minimally invasive technique to treat chronic subdural hematomas, serious bleeding in the membrane between the skull and the brain caused by head trauma.
Board-certified neurosurgeon Tsz Yeung Lau, M.D., recently performed a successful meningeal artery embolization (MAE) to stop a patient’s bleeding. The patient – a woman in her 80s – was on blood thinners for a heart condition and had recently hit her head during a fall. The bleeding was causing severe, debilitating headaches.
The procedure involves inserting a catheter into an artery in the patient’s leg or arm and advancing it to the site of the bleed. A glue-like substance or wire coil is then injected or inserted into the artery to seal off the affected portion and prevent further blood loss. It can be completed in less than an hour and often provides immediate relief while reducing the risk of more serious complications.
“This is a relatively new technique that can be used in place of the more traditional surgical repair of a subdural hematoma, which requires removal of a portion of the skull to access the bleed,” said Lau. “The traditional method is a very serious surgery that requires general anesthesia and a lengthy recovery, and many older patients – who most commonly suffer from subdural hematomas – don’t tolerate it well. MAE is safe, effective, and does not require general anesthesia. Most patients are able to go home from the hospital the next day.”
Chronic subdural hematomas are common in older adults because of physical changes to the brain that occur with aging. The veins in the membranes between the brain and the skull are thinner and stretched out, and more likely to tear in the event of an accident or fall. Because the bleeding occurs slowly, it can take weeks for symptoms to appear.
Individuals who take blood thinners are at increased risk, too, since even a minor tear in a blood vessel can cause severe bleeding.
“Seniors and individuals who take blood thinners should get checked by a physician any time they have even a minor accident that involves hitting their head, such as a fall,” said Lau. “Chronic subdural hematomas are fairly common in older adults, and they can be very serious if left untreated. Without a thorough medical evaluation, it’s easy to overlook the incident until symptoms become debilitating.”
Lau said patients with the most serious subdural hematomas aren’t eligible for MAE, but it generally can be performed on patients who have yet to progress to seizures or loss of function. In addition, some patients treated with MAE will later require surgery for a full recovery, but in the meantime, the procedure eliminates the chronic bleeding which can lead to serious complications and reduces the risk of a future bleed.
Just days after the initial MAE procedure, Lau treated another patient suffering an arteriovenous malformation (AVM) with the same catheter-based technique. AVM is a condition caused by abnormal connections between arteries and veins that can lead to headaches, seizures, paralysis, and other serious issues.
Lau and his colleagues at the Houston Methodist Neuroscience & Spine Center at Sugar Land offer comprehensive treatment options for a wide range of neurological conditions.
“We are constantly striving to bring the latest procedures and techniques to our patients,” said Lau. “Being able to provide breakthrough treatments close to home is an important part of our mission.”