I haven't seen this complication but while discussing the management of SDH for a friend who was advised MMA embolisation with a neurosurgeon colleague , the first thing he told me was that although the procedure is safe, the interventional radiologist must look for aberrant origin of ophthalmic artery prior to the procedure and if present maybe go beyond that and embolise( I m not sure if that's possible )
My friend was an army pt and I discussed all this with interventional radiologist on phone ,who said maybe this SDH can be observed and my friend did not undergo the procedure and came back to Chennai.
He has a SDH which is not increasing in size under observation but I was skeptical all these days ( it happened not even a month back) if I should have let the neuroradiologist do the procedure without putting her on guard with my queries.
But today morning when I saw this post on NANOS, felt that God was answering…:)
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Shikha
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Original Message:
Sent: 06-18-2025 17:27
From: Jeffrey Odel
Subject: MMA Occlusion & ION
We saw a case of a 65 YO female with bilateral subdurals who was treated by bilateral MMA occlusions at one sitting who awoke with bilateral CRAOs and cortical infarcts. Horrible outcome. Probably should have the MMa occlusions on separate sittings. Sometimes the ophthalmic artery comes off the middle meningeal and vice versa, See Articles by Bonasia on anatomy of of middle meningeal artery and its anastomoses.
Original Message:
Sent: 6/18/2025 3:48:00 PM
From: Nathan Lambert-Cheatham
Subject: RE: MMA Occlusion & ION
I had one case in a patient after MMA embolization. They were a bad vasculopath who had some aberrant vessels leading to the ophthalmic artery that were not well appreciated on pre-embolization angiography.
Original Message:
Sent: 6/18/2025 3:43:00 PM
From: Michael Altman
Subject: RE: MMA Occlusion & ION
Middle meningeal can send branches through the superior orbital fissure or other foramina to connect with the
ophthalmic artery and its branches
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Original Message:
Sent: 6/18/2025 3:41:00 PM
From: Edward Cohn
Subject: MMA Occlusion & ION
I just had a 65 y/o M case of monocular (OS) optic neuropathy immediately following bilateral middle meningeal artery occlusion (coiling elsewhere) for treatment of recurrent subdural hematoma. Right femoral artery entry.
Has anyone else seen this? Is this just one of those rare complications due to the increased vasculature (noted on imaging) of the left orbit.
Thank you and best wishes to all
Edward M. Cohn, MD, mba, mph
3535 W. 13 Mile (506)
Royal Oak, MI 48073
Ph: 248-551-8282
Fax: 248-551-9085
edcohnmd@umich.edu