Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma. (21st May 2020)

• Record Type: Journal Article
• Authors: Shotar, Eimad; Meyblum, Louis; Premat, Kevin; Lenck, Stéphanie; Degos, Vincent; Grand, Teodor; Cortese, Jonathan; Pouvelle, Arnaud; Pouliquen, Geoffroy; Mouyal, Samuel; Boch, Anne-Laure; Carpentier, Alexandre; Sourour, Nader-Antoine; Mathon, Bertrand; Clarençon, Frédéric
• Is Part Of: Journal of neurointerventional surgery. Volume 12:Number 12(2020)
• Page Start: 1209
• Page End: 1213
• Publication Date: 2020-05-21
• Subjects: chronic subdural hematoma -- middle meningeal artery -- recurrence -- embolization; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2020-016048
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Embolization of the middle meningeal artery (MMA) has emerged as a potential treatment of chronic subdural hematomas (CSDHs). Objective: To evaluate the impact on recurrence rate of postsurgical embolization of CSDH in patients with a higher than average risk of recurrence. Methods: A monocentric retrospective study was performed on retrospectively collected data. From March 2018 to December 2019, embolization of the MMA was proposed as an adjunct postoperative treatment after burr-hole surgery in patients operated for a recurrent CSDH or a CSDH with an independent recurrence risk factor, including antiplatelet therapy, full anticoagulation therapy, coagulation disorder, hepatopathy, or chronic alcoholism. Patients who had undergone postoperative embolization were compared with a historic group of patients operated between March 2016 and March 2018, selected based on the same inclusion criteria. Results: During the study period, 89 patients (with 74 unilateral and 15 bilateral CSDHs) were included and underwent an embolization procedure, leading to 91 out of a total of 104 MMA being embolized (88%). These were compared with 174 patients (138 unilateral and 36 bilateral CSDH) in the historic control group. One major procedure-related adverse event was registered. Four of the 89 patients (4%) required surgery for a CSDH recurrence in the embolization group, significantly less than the 24 of 174 patients (14%) in the control group (OR=0.28, 95% CI 0.07 to 0.86, p=0.02). Conclusions: Postsurgical embolization of the MMA may reduce the recurrence rate of CSDHs with a risk factor of recurrence.