Peter Kan1, Georgios A Maragkos2, Aditya Srivatsan1, Visish Srinivasan1, Jeremiah Johnson1, Jan-Karl Burkhardt1, Timothy M Robinson2, Mohamed M Salem2, Stephen Chen3, Howard A Riina4, Omar Tanweer4, Elad I Levy5, Alejandro M Spiotta6, Sami Al Kasab6, Jonathan Lena6, Bradley A Gross7, Jacob Cherian8, C Michael Cawley8, Brian M Howard8, Alexander A Khalessi9, Aditya S Pandey10, Andrew J Ringer11, Ricardo Hanel12, Rafael A Ortiz13, David Langer13, Cory M Kelly14, Brian T Jankowitz15, Christopher S Ogilvy2, Justin M Moore2, Michael R Levitt14, Mandy Binning16, Ramesh Grandhi17, Farhan Siddiq18, Ajith J Thomas2. 1. Department of Neurosurgery, Baylor College of Medicine, Houston, Texas. 2. Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. 3. Department of Radiology, Baylor College of Medicine, Houston, Texas. 4. Department of Neurosurgery, NYU Langone Medical Center, New York City, New York. 5. Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York. 6. Department of Neurosurgery, Medical College of South Carolina, Charleston, South Carolina. 7. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 8. Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia. 9. Department of Neurosurgery, University of California, San Diego, La Jolla, California. 10. Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. 11. Mayfield Clinic, TriHealth Neuroscience Institute, Good Samaritan Hospital, Cincinnati, Ohio. 12. Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida. 13. Department of Neurosurgery, Lenox Hill Hospital, New York City, New York. 14. Department of Neurological Surgery, University of Washington, Seattle, Washington. 15. Cooper Neuroscience Institute, Camden, New Jersey. 16. Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania. 17. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah. 18. Department of Neurosurgery, University of Missouri, Columbia, Montana.
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.
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.
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