Primary Middle Meningeal Artery Embolization for Non-Acute Subdural Hematoma: A Multi-Institutional Retrospective Review of Particle versus Liquid Embolic Agents. (16th November 2020)

• Record Type: Journal Article
• Authors: Scoville, Jonathan; Joyce, Evan; Taussky, Philipp; Grandhi, Ramesh
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_509
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Endovascular embolization of the middle meningeal artery (MMA) for the treatment of non-acute subdural hematoma (NASH) is both safe and efficacious and appears to have lower recurrence rates when compared to open surgery. There are two main materials used to preform MMA embolization, particles or liquids, and despite the early successes in the treatment of NASH with MMA embolization, no consensus exists. METHODS: Using a multi-institutional registry of patients with NASH that underwent MMA embolization, 132 patients that underwent primary MMA embolization for NASH were identified and separated by embolic agent. The two groups were tested for differences in radiographic outcome with 50% NASH reduction at 90 days defining success. They were also tested for differences in clinical outcome using need for surgical retreatment at 90 days to define success. Pearson's Chi Square test and Fisher's exact test were used where appropriate. A survival analysis was done to identify differences in time to 50% reduction between groups. RESULTS: Of the 132 patients that underwent primary MMA embolization, particles were used in 101 (76.5%), whereas liquids were used in 31 (23.5%). There was no difference in the proportion of patients that reached 50% NASH reduction, 62 (61.4%) and 20 (64.5%) in the particle and liquid groups respectively ( P = .753). There was no difference in the proportion needing NASH retreatment, 8 (8.1%) and 0 in the particle and liquid groups respectively ( P = .197). The hazard ratio of 2.02 was significant ( P = .008) demonstrating that NASH reduce to 50% of their original size twice as fast when using liquid embolics as compared to particles. CONCLUSION: There is no significant difference in the type of embolic agent used in obtaining 50% reduction in NASH or avoiding retreatment when treating NASH with primary MMA embolization. However, liquid embolics appear to reach a 50% reduction in NASH twice as fast as particles in the same population.