Ambooj Tiwari1,2,3,4, Adam A Dmytriw2, Ryan Bo1,3, Nathan Farkas1,5, Phillip Ye1,3, David S Gordon3, Karthikeyan M Arcot1,3, David Turkel-Parrella1,3, Jeffrey Farkas1,3. 1. Interventional Neuro Associates, 43 Westminster Avenue, Bergenfield, NJ 06721, USA. 2. Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. 3. Departments of Neurology, Radiology & Neurosurgery, NYU School of Medicine & New York University Langone Health, Brooklyn, NY 11220, USA. 4. Department of Vascular Neurology & Neurointerventional Surgery, NYU Grossman School of Medicine, 150 55th Street, Brooklyn, NY 11220, USA. 5. Department of Neurology, Washington University at St. Louis, 660 S Euclid Ave, St. Louis, MO 63110, USA.
Abstract
OBJECTIVE: To study the efficacy of middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematoma (SDH) and characterize its post-embolization volumetric resolution. METHODS: Ten patients diagnosed with 13 cSDH underwent MMA embolization. SDH volumes were measured from time of initial discovery on imaging to pre-operative, post-operative, short-term and long-term follow-up. Time between procedure to obliteration was also measured. Volumetric analysis was done using the coniglobus formula, and recurrence rate as well as resolution timeline was defined using best-fit models. RESULTS: Out of 10 patients, five were recurrent lesions, three were bilateral and seven unilateral cSDH. Average and median pre-operative volumes were 105.3 cc and 97.4 cc, respectively. Embolization on average was performed 21 days after discovery. Sixty percent of patients had concurrent antiplatelets or anticoagulation use. Forty percent underwent embolization treatment as the primary therapy. Recurrence was not seen in any patients treated with embolization. There were no peri- or post-operative complications. Five patients experienced complete or near-complete obliteration, while those with partial resolution showed a composite average of 75% volumetric reduction in 45 days. Post-embolization, the volumetric resolution followed an exponential decay curve over time and was independent of initial volume. CONCLUSION: MMA embolization contributed to a marked reduction in SDH volume post-operatively and can be used as a curative therapy for primary or recurrent chronic SDH.
OBJECTIVE: To study the efficacy of middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematoma (SDH) and characterize its post-embolization volumetric resolution. METHODS: Ten patients diagnosed with 13 cSDH underwent MMA embolization. SDH volumes were measured from time of initial discovery on imaging to pre-operative, post-operative, short-term and long-term follow-up. Time between procedure to obliteration was also measured. Volumetric analysis was done using the coniglobus formula, and recurrence rate as well as resolution timeline was defined using best-fit models. RESULTS: Out of 10 patients, five were recurrent lesions, three were bilateral and seven unilateral cSDH. Average and median pre-operative volumes were 105.3 cc and 97.4 cc, respectively. Embolization on average was performed 21 days after discovery. Sixty percent of patients had concurrent antiplatelets or anticoagulation use. Forty percent underwent embolization treatment as the primary therapy. Recurrence was not seen in any patients treated with embolization. There were no peri- or post-operative complications. Five patients experienced complete or near-complete obliteration, while those with partial resolution showed a composite average of 75% volumetric reduction in 45 days. Post-embolization, the volumetric resolution followed an exponential decay curve over time and was independent of initial volume. CONCLUSION:MMA embolization contributed to a marked reduction in SDH volume post-operatively and can be used as a curative therapy for primary or recurrent chronic SDH.
Authors: Andrea Di Cristofori; Paolo Remida; Mirko Patassini; Lorenzo Piergallini; Raffaella Buonanno; Raffaele Bruno; Giorgio Carrabba; Giacomo Pavesi; Corrado Iaccarino; Carlo Giorgio Giussani Journal: Surg Neurol Int Date: 2022-03-18