Aim: The aim of the projeck is to integrate early neurorehabilitation into the healthcare system for patients with acquired severe brain injury in the Czech Republic.Objectives. Methods: The intensive neurorehabilitation (NINR) pilot project implements phase B1 of the neurorehabilitation phase model, which is defined as the early rehabilitation phase. During this phase, intensive care must be provided if necessary, including the possibility of artificial pulmonary ventilation. Patients indicated for admission to the NINR facility are conditiontransferred from intensive or acute neurosurgical care units, such as traumatic brain injury, inflammatory brain dis ease, brain tumor, cerebral stroke or impaired cerebrospinal fluid production, flow and resorption. Admission is possible within one month of the onset of the condition, according to admission criteria. The maximum duration of care provided to one patient at NINR facility is 12 weeks. If necessary, the length of stay at an NINR facility can be prolonged due to a deferred prognosis; in such cases, an ,indication seminar` is held with representatives of the health insurance company in attendance, where justification for such a proposal is assessed and further actions are recommended. A stay at the NINR facility will end if there has been no improvement for an uninterrupted period of up to six weeks, or ifa Barthel Index value of 30 has been achieved at anytime during the stay. Under the NINR program, patients receive up to 12 weeks of 3 to 4 h of intensive therapy per day. Results: The project is currently operating at three locations in the Czech Republic. As of the end of June 2025, early neurorehabilitation as part of the project had been completed in 122 patients, who were admitted on average 18 days after the onset of acute illness. The average hospitalization time at NINR facility was 45.8 days. Upon admission, 53.6% of patients were on mechanical ventilation, compared to 9.7% at discharge. Of those admitted with tracheostomy (79.5%), 29.5% remained upon discharge. A Barthel Index score of 30 or more was achieved by 75 (61.5%) patients at discharge. 38% were able to progress to the next phase of rehabilitation, 30% were transferred to fol lowor longintensive care units, and 11%were released to home care. Conclusion:The project results demonstrate the feasibility of successfully implementing this approach into the healthcare system in the Czech Republic. Following the completion of the project, we hope to extend this care to other facilities.
Introduction: Herniated disc is a common cause of lumbar radiculopathy. Full endoscopic discectomy is a minimally invasive alternative to microdiscectomy. The aim of the study was to evaluate the results and complications of endoscopic procedures and to compare the transforaminal and interlaminar approaches. Methods: A retrospective analysis included 64 patients (40 men, 24 women; mean age 51.2 years). Transforaminal approach was performed in 12 patients and interlaminar in 52 patients. In both groups, we evaluated the duration of surgery, X-ray exposure, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) (before the procedure, at discharge, 3 and 12 months after surgery), postoperative complications, and the frequency of postoperative recurrence of herniated disc. Results: The mean duration of surgery was 62 min. X-ray exposure was longer with the transforaminal approach (43 s) than with the interlaminar approach (22 s; P < 0.001). VAS decreased from 7.4 +/- 1.2 to 1.3 +/- 0.8 at 12 months (P < 0.0001), and ODI from 56% +/- 13% to 14% +/- 9% (P < 0.0001). No significant difference was found between the transforaminal and translaminar approaches in VAS and ODI. The results are valid for the entire group of patients. The overall complication rate was 14.0%. We recorded dural sac injuries twice (3.1%) without the need for surgical revision. Recurrence of disc herniation was recorded in 7 patients (10.9%). Conclusion: Transforaminal and translaminar endoscopic extirpation of intervertebral disc herniation is an effective and safe method with rapid recovery and low morbidity. The translaminar approach is suitable for centrolateral herniations, where it allows a more direct and anatomically clearer approach to the pathology with better control of the dural sac and nerve root and is associated with lower technical demands. The transforaminal approach is used for medial and laterally localized intervertebral disc herniations. The advantage is the preservation of the integrity of the spinal canal with minimal manipulation of the dural sac. However, it is technically more demanding and the result depends on the experience of the surgeon.
Academician Kamil Henner ranks among the most prominent figures in 20th-century Czechoslovakian neurology.This article outlines not only his exceptional professional contributions, but also the key milestones of his life and his personality. Henner began his career at the First Department of Internal Medicine under Ladislav Syllaba, where he gradually established himself as a neurologist and built his own school of disciples. In 1937, he became the head of the Neurology Department at the General Hospital, but his early tenure was significantly affected by the events of World War II, during which Henner and his colleagues became actively involved in the resistance. After World War II, Henner succeeded in transforming the department into a leading center for neurology. Henner's scientific work was remarkably broad and productive; he authored more than 300 publications. His pedagogical influence was equally important-both at the undergraduate level, where he improved the quality of neurological education, and at the postgraduate level, where he trained an entire generation of neurologists, many of whom later achieved the highest academic positions. His death marked the end of an era in Czechoslovakian neurology.
Background: Parkinson's disease is a neurodegenerative disorder that not only affects motor functions, but also speech and voice production. Music therapy represents a promising non-pharmacological approach to support communication in this population. Objectives: This interventional studyaimed to evaluate the impact ofan original structured music therapy program on speech intelligibility, voice quality, and spontaneous speech production in individuals with Parkinson's disease. Methods: Study participants (N = 17) participated in an eight-week structured group program focused on voice, breathing, articulation, and singing. Pre-and post-intervention assessments included the GRBAS scale, a speech intelligibility test, and the Analysis ofSpontaneous Speech (ASpoR) tool to evaluate spontaneous speech. Data were analyzed statistically using descriptive and inferential methods with effect size calculation. Results: Participants demonstrated consistent improvement in overall speech intelligibility, with a significant gain in the combined score (P = 0.0099, d = 0.71). GRBAS scores improved descriptively, though not significantly, with large effect sizes for breathiness (r = 0.83) and strain (r = 0.67). While fluency and error rates in spontaneous speech showed no significant change, the intervention significantly enhanced self-monitoring, as evidenced by a higher percentage of corrected errors relative to total errors (P = 0.00097, r = 0.87), and a reduced ratio of uncorrected to corrected errors (P = 0.00049, r = 0.87). Conclusion: The program improved several aspects of communication, suggesting the therapeutic potential of music therapy for this population.
Backgroundandobjective:Although intravenous thrombolysis(IVT) isa recommended recanalization therapy for ischemic stroke, it is associated with a risk of symptomatic intracranial hemorrhage. This academic clinical study aims to evaluate the relationship between fibrinogen levels and their drop measured at 6 and 24 h after IVT and the risk of intracranial hemorrhage, specifically parenchymal hematoma, which is the most clinically significant type of intracranial hemorrhage. Methods: Seven primary stroke centers and comprehensive stroke centers in the Czech Republic will be involved in the multicenter retrospective study. The estimated total number of patients enrolled in the observation and control groups is 300, with defined entry parameters maintained. The parameters monitored include personal and pharmacological history, laboratory parameters, neurological findings, and imaging results. Results: The study will evaluate the degree of association between fibrinogen levels and their drop measured at 6 and 24 h after IVT and the risk of parenchymal hematoma. Conclusion: Evidence of an association between the development of parenchymal hematoma and a decrease in fibrinogen levels in patients with ischemic stroke treated with IVT may be used to design an interventional study with fibrinogen replacement to prevent bleeding.
Aim: This article explores brain death assessment according to neurological criteria and evaluates a nationwide survey on diagnostic procedures. It also examines awareness among healthcare professionals. Methods: An online survey was conducted from January 7 to March 3, 2025, targeting 115 healthcare facilities. The questionnaire collected demographic data, specialties, and frequency of brain death assessments and examination of individual reflexes. Results: 523 respondents participated in the questionnaire survey, with 38% having experience in brain death assessment. A total of 187 physicians regularly examine brain death, with 74% of them performing fewer than five examinations per year. The most common specialists were anesthesiologists (48%) and neurologists (27%). Most physicians (50%) follow the IKEM "& Zcaron;ivot2" manual. The main reason for the examination (61%) was the donor program. The apnea test is performed by 81% of respondents, 90% of them only after a clinical examination. The most commonly used confirmatory method is CTA (26%), while 43% of physicians indicate confirmatory testing only in the case of a donor program. Conclusion: A questionnaire survey revealed the existence of interindividual differences in the investigative procedure for clinical determination of brain death in the Czech Republic. The consistency of clinical examinations is insufficient in patients referred to the donor program. In contrast, the apnea test is unnecessarily overused in examinations conducted as part of the decision-making process regarding futile care limitations. The findings emphasize the need for enhanced education on brain death assessment, particularly those who rarely encounter this diagnosis. It is also crucial to understand the concept of brain death and how it is communicated both among healthcare professionals and to the public.
Ladislav Haskovec was the central founding figure in the field of neurology in the Czech lands. For three decades, he advocated the recognition of neurology as an independent teaching and clinical discipline; however, it was not until 1926 that he succeeded in establishing the "University Department for Nervous Diseases" at the Faculty of Medicine of Charles University. He was then granted only ten years to lead the department. A persistent motive of his career was not merely the scientific development of the field, but also a sustained struggle for beds, outpatient facilities, laboratories, and personnel-in other words, for the "infrastructure" of the discipline. The article tracesHaskovec 's professional trajectory from his habilitation in neuropathology in 1896, through the establishment of the first neurological outpatient clinic and ward at Na Franti & scaron;ku Hospital, to the institutional consolidation of the department in the former monastery at Karlov. Drawing on archival sources, it analyses the circumstances of its foundation, its staffing conditions, and the role of Haskovec `s collaborators and pupils. The study also addresses the question of his priority among habilitated neurologists in the Czech lands and situates his work within the broader Central European context of the emergence of modern neurology.
Objective: The study compares the health status of pediatric patients after prenatal and postnatal surgical treatment of open neural tube defects in order to determine the success of the above approaches in the treatment of patients. Methods: The retrospective study analyzes the health status of 12 prenatally and 17 postnatally operated patients between 2016 and 2024. Fetal procedures were performed at the Spina Bifida Center at the Children's Hospital in Z & uuml;rich, Switzerland, and postnatal surgeries were performed at National Institute of Childrens Diseases in Bratislava, Slovakia. Results: We recorded the following values in prenatally and postnatally operated patients-the incidence of shunt-dependent hydrocephalus was 33.33% and 47.06%; psychomotor development was slowed down in 25% and 23.53%;41.67%and 52.94%were able to walk independently, or walk independently with orthopedic aids; neurogenic bladder was present in 66.67% and 58.88%; and neurogenic obstipation was found in 41.67% and 41.18% of patients, respectively. Arnold-Chiari malformation type II occured in 91.67%of patients after prenatal surgery and in 100% of patients after postnatal surgery. Conclusion: We consider prenatal correction of open neural tube defects to be effective and beneficial due to the lower rate of need for surgical interventions for hydrocephalus and the lower number of children whose mobility depends on another person or a wheelchair.
Spontaneous intracerebral hemorrhage (SICH) represents a significant subtype of acute stroke with high morbidity and mortality. Comprehensive SICH management aims to increase survival rates and improve clinical outcomes of patients with this disease. The guidelines cover the areas of care organization, diagnosis, medical treatment (acute blood pressure lowering and hemostatic treatment), surgical treatment, prevention and treatment of complications, secondary prevention, prediction of the final clinical condition and care goals, rehabilitation and neurobehavioral complications, quality control, and discharge report requirements. The presented guidelines for the management of SICH in adult patients represent a consensus opinion of the committees of the Czech Neurological Society of the Czech Medical Association JEP, and the Czech Neurosurgical Society of the Czech Medical Association JEP.
Objective: The aim of this study was to translate and validate the psychometric properties of the Patterns of Activity Measure-Pain in the Czech language. This tool assesses behavioral patterns related to physical activity in patients with chronic pain. As no validated instrument of this kind currently exists in the Czech context, the adaptation of the assessment tool represents an important contribution to diagnostic assessment and the individualization of therapeutic interventions in this population. Methods: A total of 151 patients (18-65 years) with chronic low back pain were included in the study. The instrument was linguistically adapted following international guidelines. Subsequently, exploratory and confirmatory factor analyses were conducted. Internal consistency was evaluated using Cronbach's alpha, and convergent and concurrent validity were assessed through correlations with other validated instruments. Results: A three-factor structure of the tool (avoidance, overdoing, and activity pacing) was confirmed. The final confirmatory factor analysis model, after removing three items, showed an acceptable model fit. Internal consistency for the domains ranged from 0.89 to 0.94. Convergent and concurrent validity were supported by correlations with pain intensity, quality of life, psychological distress, and physical activity level. Conclusions: The Czech version of the Patterns of Activity Measure-Pain demonstrates good psychometric properties and can be considered as a reliable instrument for both clinical and research use in assessing activity-related behavioral patterns in patients with chronic low back pain.
Aim: This study aimed to evaluate the outcomes of surgical treatment for compressive and traumatic neuropathies of the deep branch of the radial nerve (DBRN), with an additional focus on epidemiology, anatomical considerations linked to DBRN lesions, and complications. Materials and methodology: Records of patients surgically treated for peripheral nerve lesions were retrospectively reviewed to compile data on demographic details, anatomical location of the lesion, surgical management, outcomes, and complications. The primary outcome measure was the Louisiana State University and 7 traumatic neuropathies, were included. The median fol low-up was 17.5 (14- 41) months. Surgical intervention led to a signifi cant improvement in the LSUHSC score in both the compressive (from 2 [0- 31 to 4 [2- 51; P = 0.018) and the traumatic neuropathy group (from 0 [0- 01 to 3 [0- 41; P = 0.011). The traumatic neuropathy group exhibited a significantly lower preoperative LSUHSC score (P = 0.004), but the difference in postoperative scores was not significant (P = 0.129). Primary surgical treatment failed in 26.7% of patients with compression and in 28.6% of patients with DBRN injury. Tendon transfer presented a viable solution for patients with failed primary treatment. Conclusion: Surgical treatment provides significant functional improvement in patients with compressive and traumatic neuropathies of the DBRN. However, a considerable percentage of patients in both groups experienced primary treatment failure. Although patients with traumatic neuropathies of the DBRN presented with a worse preoperative functional status, the postoperative outcomes between both groups were comparable.
Introduction: Sexual dysfunction (SD) is a common, but often underestimated and inadequately addressed symptom in men and women with MS.The prevalence ofSD has not been systematically described in Czech MS patients, and therefore our aim was to map the prevalence of SD in women with MS, including possible associated factors. Methods: The standardized questionnaire Female Sexual Function Index (FSFI) was used to assess SD. The FSFI questionnaire was distributed in a long-term prospective study (monitoring disease course and symptoms) to a total of 251 women with MS (mean age of patients was 43.3 +/- 8.9 years; with a mean disease duration of 14.7 +/- 6.2 years). Results: The complete questionnaire was completed by 147 women (response rate 58.5%). A total of 48 respondents (32.6%) were identified as having SD. When compared with the rate of neurological disability, a weak to moderate negative correlation was found with the total Expanded Disability Status Scale score (0.481; P = 0.002). Patients with SD were older (P = 0.001), with a longer disease duration (P = 0.012) and higher rates of neurological disability (P = 0.001). Conclusion: Sexual dysfunction in women with MS seems to be mainly associated with sensory dysfunction. It was also more prevalent in older women with longer disease duration. Therefore, it is recommended for the clinical practice to ask specifically about the possible occurrence of SD especially in women with sensory symptoms.
Background: Stroke is the second most common cause of death in the Czech Republic. Ischemic stroke accounts for more than 3 of all strokes. In 2020, the incidence of ischemic stroke was 211 cases per 100,000 people per year, and the prevalence is estimated at 240,000 cases. Post-stroke depression (PSD) affects approximately one third of patients after ischemic stroke and significantly affects rehabilitation and quality of life. The aim of our work was to determine the frequency of PSD after the first ischemic stroke in our department and to evaluate the interest of patients in drug and experimental treatments. Methodology: The study included patients hospitalized after the first ischemic stroke without previous depression and aphasia. Depression screening was performed using the Beck Depression Inventory (BDI-II) first after 3 months in the outpatient clinic, and later during hospitalization after protocol modification. Results: 40 patients were examined in the outpatient phase, out of whom 12 (30%) were depressed. Only 3 patients agreed to a psychiatric examination. After the protocol change, 300 patients were examined during hospitalization, 51 (17%) were screened as depressed, and 43 patients (14.3%) were treated with antidepressants. Conclusions: The prevalence of PSD reached 17-30% depending on the timing of screening. A fundamental problem is the low compliance of patients with psychiatric care due to stigmatization. Screening during hospitalization appears to be more practical than outpatient monitoring.
Aim: Hemangioblastomas are benign, highly vascular tumors that originate within the central nervous system. Histologically, these tumors are composed of stromal cells embedded in a dense network of blood vessels. The aim of the study was to present our surgical outcomes in sporadic cerebellar hemangioblastomas and to investigate the relationship between the cystic component size and the presence of hydrocephalus and associated clinical findings. Materials and methods: We retrospectively reviewed 29 adult patients with sporadic cerebellar hemangioblastomas operated by a single surgeon between 2010 and 2022. Tumors were classified as solid, small cystic (< 2.5 cm), or large cystic (>= 2.5 cm). Clinical, imaging, and surgical data were analyzed, and functional outcomes were measured using the modified Rankin Scale (mRS) and Karnofsky Performance Scale (KPS) scores. The relationship between cyst size, hydrocephalus, and neurological outcome was also examined. Results: Larger cysts were significantly linked to hydrocephalus (P = 0.038) and cerebellar symptoms (P = 0.026). Regression suggested a possible association between cyst size and these findings (P = 0.062 and P = 0.053). Cyst and nodule sizes showed moderate correlation (r = 0.520; P = 0.013). Cysts were also larger in patients needing an external ventricular drain (41,00 vs. 28,78 mm; P = 0.053). No significant differences were found between groups in mRS or KPS scores before and 1 year after surgery (P > 0.6). Conclusion: Hemangioblastomas are benign, but their posterior fossa location often causes significant symptoms. En bloc resection of the nodule with wide craniotomy remains the best treatment. This study highlights the link between large cysts and hydrocephalus, suggesting early surgery may improve outcomes.
Background and objectives: The eligibility of acute ischemic stroke (AIS) patients with pre-existing neurological disability (modified Rankin Scale [mRS] >= 3) for acute reperfusion therapy remains uncertain. The aim was to identify factors predicting the return to their baseline functional status after reperfusion therapy in AIS patients with premorbid disability (pre-stroke mRS >= 3). Methods: We analyzed data from patients with premorbid disability from the Czech national registry for intravenous thrombolysis/endovascular treatment (2016-2020). The primary outcome was return to baseline mRS (Delta mRS = 0) at 3 months. Using multivariate logistic regression, we identified predictors of this outcome. Results: Among 1,712 patients, 32.1% (275/ 857) returned to their baseline status. Independent predictors of successful return included: age (adjusted odds ratio [aOR] 0.97 per year, 95% confidence interval [CI] 0.95-0.98), baseline National Institutes of Health Stroke Scale (NIHSS) (aOR 0.94 per point, 95% CI 0.92-0.96), absence of atrial fibrillation (aOR 0.78, 95% CI 0.63-0.97), and onset-to-treatment time (aOR 0.99 per minute, 95% CI 0.98-0.99). Patients with premorbid mRS 3 were more likely to return to baseline than those with an mRS 4-5 (aOR 1.42, 95% CI 1.18-1.67). Reperfusion was more effective in patients with atherothrombotic stroke etiology (aOR 1.69, 95% CI 1.31-2.14) compared to cardioembolic etiology (aOR 1.21, 95% CI 0.95-1.53). Discussion: Younger age, lower NIHSS, absence of atrial fibrillation, atherothrombotic etiology, and faster treatment commencement are key predictors of regaining baseline functional status after reperfusion in AIS patients with premorbid disability.
The Department of Psychiatry and Neurology of the German Charles University in Prague was among the leading medical institutions in Central Europe in the early 20th century. In October 1939, Professor Kurt Albrecht, a Berlin neurologist and member of both the NSDAP and the SS, was appointed head of the department. During his tenure, he secured a separate building for the neurological section and held senior academic positions, including dean of the medical faculty, and finally, he even became the last rector of the German Charles University. Albrecht's death at the end of the Second World War remains a mystery. Contemporary accounts differ, some attributing it to suicide, and others to his death in armed resistance. While his career is inseparably linked with the Nazi regime, he remains part of the lineage of chiefs of the department, which history forms a broader professional tradition beyond political entanglements. In re-examining the circumstances of his death, we combined established sources with newly identified unpublished archival material from Prague and Berlin, as well as testimonies of contemporaries from German University circles in Prague. These findings contribute to a more nuanced portrait of Albrecht and his era, inviting interpretations that extend beyond narrow national frameworks or the postwar perspective.
Background: Hypertensive cerebral hemorrhage is a common cerebrovascular disease. Aim: This study aimed to assess the effects of whole-course case management in combination with mind mapping on the neurological functions and prognosis of patients receiving hematoma evacuation for hypertensive cerebral hemorrhage. Methods: A total of 130 patients who underwent hematoma evacuation for hypertensive cerebral hemorrhage were retrospectively included and assigned into a case group (N = 66, given whole-course case management plus mind mapping) and a conventional group (N = 64, given conventional nursing). Neurological functions, activities of daily living, exercise ability, blood pressures, mental state, and complications were compared between the two groups. Categorical variables were expressed as absolute numbers and percentages, and compared between groups using the Chi-square test. Normally distributed data were expressed as (mean +/- standard deviation) and subjected to the t-test. Results: After intervention, both groups showed significant improvements in Fugl-Meyer Assessment scores, with the case group demonstrating significantly higher scores than the conventional group (P < 0.05). The positive affect score significantly increased, whereas the negative affect score significantly decreased in both groups, and the case group displayed significant increases in the positive affect score and reductions in the negative affect score in comparison to the conventional group (P < 0.05). The total incidence rate of complications was significantly lower in the case group than in the conventional group (7.58 vs. 21.88%; P < 0.05). Conclusion: The nursing model combining whole-course case management with mind mapping is capable of boosting the recovery of neurological functions, enhancing the activities of daily living and exercise ability, and stabilizing the blood pressure in patients with hypertensive cerebral hemorrhage receiving hematoma evacuation.
Background: Acute ischemic stroke (AIS) patients tend to have rapid disease progression, with collateral circulation gradually failing over time. Aim: We aimed to investigate the preoperative collateral circulation state in AIS patients undergoing mechanical thrombectomy and its association with clinical prognosis. Methods: Subjects (N = 112) were recruited from AIS patients receiving mechanical thrombectomy during January 2019 and December 2022. The preoperative collateral circulation state in ischemic regions was assessed. Analyses were carried out on different occlusion sites and potential compensation pathways of collateral circulation. Results: Subjects presenting poor preoperative collateral circulation had a significantly raised prognostic modified Rankin Scale (mRS) score compared with those exhibiting good preoperative collateral circulation (P < 0.05). The preoperative collateral circulation state displayed a significantly positive correlation with prognosis (r = 0.834; P < 0.05). The baseline National Institutes of Health Stroke Scale score, time from admission to recanalization, modified Thrombolysis in Cerebral Infarction score, and preoperative collateral circulation state were risk factors in terms of prognosis (P < 0.05). Sensitivity, area under the curve, and specificity of preoperative collateral circulatory state for predicting the prognosis reached 89.60%, 0.879 (95% CI = 0.800-0.945), and 86.53%, respectively. Conclusion: Collateral circulation before mechanical thrombectomy has a significant relationship to AIS patients' prognosis, and a poor one serves as a risk factor independently influencing the prognosis.
Aim: To propose a methodology for the early diagnosis of tuberous sclerosis complex (TSC) based on an evaluation of a prospectively monitored cohort of children diagnosed with cardiac rhabdomyoma (CR). Methods: Diagnosis of TSC is both genetic and clinical, based on the presence of 11 major and 7 minor clinical criteria. At least two major features are required to confirm the diagnosis. The earliest major feature is prenatal detection of CR, while additional major features may be identified on brain MRI. Between 2019 and 2024, 17 children with a prenatal or perinatal finding of CR were monitored at the Department of Pediatric Neurology and the Children's Heart Centre of the Motol University Hospital. All patients underwent fetal or early postnatal echocardiography and brain MRI, with regular EEG monitoring. The children were followed from the neonatal period with the aim of diagnosing TSC and epilepsy. Results: A diagnosis of TSC was confirmed in 14 out of 17 children (83%) monitored for CR. Epilepsy manifested in 13 of the 14 TSC patients (93%), with 10 of these 13 cases occurring within the first six months of life. A care protocol for patients with prenatal or perinatal findings of CR and a recommended approach for early TSC diagnosis have been summarized in several key points. Conclusion: Examination of the fetus or newborn with CR is critical for the early diagnosis of TSC and epilepsy, enabling risk reduction for the development of epileptic encephalopathy. We propose a diagnostic methodology for TSC in the context of a prenatal or perinatal finding of CR.
Introduction: Chronic subdural hematoma (CSDH) is almost the most frequent neurosurgical diagnosis. In particular, with an aging population and the use of antiplatelet and anticoagulant therapy, these cases are on the rise. Surgical treatment, usually managed by simple burr-hole evacuation is a relatively simple and effective method of treatment. Despite the successful primary surgery, there is an increase in CSDH recurrence. Recently, minimally invasive procedures have become a trend. Endovascular embolization of the middle meningeal artery (MMA) is a relatively new and now in the world frequently used therapeutic modality. Methods: We present a series of patients treated with MMA embolization with or without trepanation. Results: Our cohort includes forty patients with CSDH-recurrent and primary. In 97.5% patients, we achieved complete resolution of CSDH after MMA embolization, one patient was re-hospitalized for another recurrence despite embolization. In three patients, MMA embolization was used as a primary and single treatment for CSDH. Conclusion: MMA embolization can be used as a single or additional treatment for CSDH recurrence. It can also be used in patients who are not suitable candidates for trepanation due to other comorbidities. MMA embolization appears to be a safe and relatively simple management of recurrences of CSDH, when the rules of endovascular treatment are followed.
