Use of Spinosum Roentgen Index (S.R.I.) to determine candidacy for middle meningeal artery embolization.

INTRODUCTION

Middle meningeal artery embolization (MMAe) is a minimally-invasive approach for the treatment of subdural hematomas (SDH). Small vessel caliber and ectopic origin of the middle meningeal artery (MMA) may lead to unsuccessful embolization and/or serious morbidity. Thus, use of an objective scale to pre-procedurally assess candidacy for MMA embolization is an essential component of operative planning.

METHODS

A retrospective analysis of all patients having undergone MMAe across 4 years at a single institution was performed.

RESULTS

169 MMAe procedures were performed for SDH, of which 3 were found to have a foramen spinosum diameter, termed the "Spinosum Roentgen Index" (SRI), measuring <2 mm on pre-procedure non-contrast CT Head. A statistically-significant correlation was found between foramen spinosum diameter <2 mm and unsuccessful embolization.

CONCLUSION

Assessment of foramen spinosum diameter (Spinosum Roentgen Index (SRI)) may increase suspicion for aberrant MMA anatomy when measuring <2 mm, which can serve as valuable data in assessing risk versus benefit of MMA embolization, and ultimately minimize unexpected intraprocedural or immediate postprocedural complications.