Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations. Issue 2 (7th October 2020)

• Record Type: Journal Article
• Authors: Kan, Peter; Maragkos, Georgios A; Srivatsan, Aditya; Srinivasan, Visish; Johnson, Jeremiah; Burkhardt, Jan-Karl; Robinson, Timothy M; Salem, Mohamed M; Chen, Stephen; Riina, Howard A; Tanweer, Omar; Levy, Elad I; Spiotta, Alejandro M; Kasab, Sami Al; Lena, Jonathan; Gross, Bradley A; Cherian, Jacob; Cawley, C Michael; Howard, Brian M; Khalessi, Alexander A; Pandey, Aditya S; Ringer, Andrew J; Hanel, Ricardo; Ortiz, Rafael A; Langer, David; Kelly, Cory M; Jankowitz, Brian T; Ogilvy, Christopher S; Moore, Justin M; Levitt, Michael R; Binning, Mandy; Grandhi, Ramesh; Siddiq, Farhan; Thomas, Ajith J;
• Is Part Of: Neurosurgery. Volume 88:Issue 2(2021)
• Page Start: 268
• Page End: 277
• Publication Date: 2020-10-07
• Subjects: Chronic subdural hematoma -- Chronic subdural hemorrhage -- Middle meningeal artery embolization -- Refractory subdural hematoma -- Refractory subdural hemorrhage; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa379
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Middle meningeal artery (MMA) embolization has emerged as a promising treatment for chronic subdural hematoma (cSDH). OBJECTIVE: To determine the safety and efficacy of MMA embolization. METHODS: Consecutive patients who underwent MMA embolization for cSDH (primary treatment or recurrence after conventional surgery) at 15 centers were included. Clinical details and follow-up were collected prospectively. Primary clinical and radiographic outcomes were the proportion of patients requiring additional surgical treatment within 90 d after index treatment and proportion with > 50% cSDH thickness reduction on follow-up computed tomography imaging within 90 d. National Institute of Health Stroke Scale and modified Rankin Scale were also clinical outcomes. RESULTS: A total of 138 patients were included (mean age: 69.8, 29% female). A total of 15 patients underwent bilateral interventions for 154 total embolizations (66.7% primary treatment). At presentation, 30.4% and 23.9% of patients were on antiplatelet and anticoagulation therapy, respectively. Median admission cSDH thickness was 14 mm. A total of 46.1% of embolizations were performed under general anesthesia, and 97.4% of procedures were successfully completed. A total of 70.2% of embolizations used particles, and 25.3% used liquid embolics with no significant outcome difference between embolization materials ( P > .05). On last follow-up (mean 94.9 d), median cSDH thickness was 4 mm (71% median thickness reduction). A total of 70.8% of patients had >50% improvement on imaging (31.9% improved clinically), and 9 patients (6.5%) required further cSDH treatment. There were 16 complications with 9 (6.5%) because of continued hematoma expansion. Mortality rate was 4.4%, mostly unrelated to the index procedure but because of underlying comorbidities. CONCLUSION: MMA embolization may provide a safe and efficacious minimally invasive alternative to conventional surgical techniques. Graphical Abstract: