319 Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Series of 57 Cases. Issue Volume 65:Issue CN(2018)Supplement 1 (16th August 2018)

• Record Type: Journal Article
• Authors: Link, Thomas W; Kamel, Hooman; Knopman, Jared
• Is Part Of: Neurosurgery. Volume 65:Issue CN(2018)Supplement 1
• Page Start: 129
• Page End: 129
• Publication Date: 2018-08-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyy303.319
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Chronic subdural hematoma (SDH) is a common pathology in neurosurgery, and is particularly difficult to treat due to high recurrence rates (11-33%) and complex medical comorbidities that tend to afflict the patient population. Recently, there have been several small case series published describing the use of middle meningeal artery (MMA) embolization as an alternative to surgery for treatment of new or recurrent chronic SDH. The authors argue that growth and recurrence of chronic SDH is due to repeated rebleeding from fragile neovasculature within the membrane that encapsulates the SDH, and that embolizing the MMA eliminates this process, allowing the brain to then resorb the collection over time. Here, we describe the largest series thus far of 57 cases of MMA embolization for chronic SDH. METHODS: IRB approval was obtained. MMA embolization was performed using angiography, selective microcatheterization of the MMA, and infusion of polyvinyl alcohol particles under blank fluoroscopic roadmap. Outcomes were assessed clinically and with follow-up CT scans at 1 d, 2 wk, and 6 wk postprocedure, and at additional intervals as indicated. RESULTS: MMA embolization was performed on 57 total SDHs in 46 patients. This includes upfront treatment for new (not previously treated) SDH in 40, for recurrence in 7, and prophylactic (soon after surgical evacuation) in 10. There were 3 mortalities (unrelated to the procedure), and no procedural complications. There were 4 (8.5%) cases of recurrence requiring surgical evacuation, and 32 (68.1%) that had resolution or reduction in size >50% of SDH at longest follow-up. Overall, 43 (91.5%) were stable or decreased in size and able to avoid surgery. CONCLUSION: MMA embolization may represent a minimally invasive alternative to surgery for new or recurrent chronic SDH. Given our encouraging results of 57 cases with a 91.5% long-term success rate, a large-scale clinical trial is warranted.