Just like not all of dura is fed by the MMA, so is subdural hematoma embolization not limited to the same vessel.
Here is a large isodense subdural
A subdural “MMA” embolization — anything unusual here?
Headway duo in the MMA— typical membranes look
Lateral — see how some parietal region dura is not opacified — whats up with that?
PVA small particle embo (Contour 45-150 microns) of the petrosquamosal branch — important to go a bit distal in this one, past facial arcade — once u r near the inner skull table its fine
Next is frontoparietal branch PVA embo — on successive images look at how the territory becomes progressively devascularized — like a tree loosing leaves with only trunk left at the end. Followed by placement of single coil
Post — still there is subdural membrane hyperemia — interesting?
Supply comes from a transosseous branch fed by the occipital artery — its a pretty big territory. Even from this position we can embolize with Contours without too much concern about skin — but better to be closer still
Rotational VRs — progressive removal of bone mask image shows the transosseous branch
Final embo position — achieved by Headway Duo and .07 Hybrid — a winning combo. Even in this position there is no flow arrest — good for PVA, and no skin damage from here.
CCA post — of course we check ophthalmic beforehand — classic intradural ICA origin
So, dural supply is not always just the MMA. Check the Meningeal Vessels page for more
Also check out this case with commentaries on our BANANAZ BITES channel on www.youtube.com/neuroangio