Middle meningeal artery embolization as a perioperative adjunct to surgical evacuation of nonacute subdural hematomas: An multicenter analysis of safety and efficacy
- 13 March 2023
- journal article
- research article
- Published by SAGE Publications in Interventional Neuroradiology
Abstract
Background By 2030, nonacute subdural hematomas (NASHs) will likely be the most common cranial neurosurgery pathology. Treatment with surgical evacuation may be necessary, but the recurrence rate after surgery is as high as 30%. Minimally invasive middle meningeal artery embolization (MMAE) during the perioperative period has been posited as an adjunctive treatment to decrease the potential for recurrence after surgical evacuation. We evaluated the safety and efficacy of concurrent MMAE in a multi-institutional cohort. Methods Data from 145 patients (median age 73 years) with NASH who underwent surgical evacuation and MMAE in the perioperative period were retrospectively collected from 15 institutions. The primary outcome was the rate of recurrence requiring repeat surgical intervention. We collected clinical, treatment, and radiographic data at initial presentation, after evacuation, and at 90-day follow-up. Outcomes data were also collected. Results Preoperatively, the median hematoma width was 18 mm, and subdural membranes were present on imaging in 87.3% of patients. At 90-day follow-up, median NASH width was 6 mm, and 51.4% of patients had at least a 50% decrease of NASH size on imaging. Eight percent of treated NASHs had recurrence that required additional surgical intervention. Of patients with a modified Rankin Scale score at last follow-up, 87.2% had the same or improved mRS score. The total all-cause mortality was 6.0%. Conclusion This study provides evidence from a multi-institutional cohort that performing MMAE in the perioperative period as an adjunct to surgical evacuation is a safe and effective means to reduce recurrence in patients with NASHs.Keywords
This publication has 31 references indexed in Scilit:
- Histopathological features of the outer membrane of chronic subdural hematoma and correlation with clinical and radiological featuresJournal of Clinical Neuroscience, 2013
- The risk factors for recurrence of chronic subdural hematomaNeurosurgical Review, 2012
- Recent Changes in Risk Factors of Chronic Subdural HematomaJournal of Korean Neurosurgical Society, 2012
- Postoperative Course and Recurrence of Chronic Subdural HematomaJournal of Korean Neurosurgical Society, 2010
- Chronic subdural haematoma: surgical treatment and outcome in 1000 casesClinical Neurology and Neurosurgery, 2004
- Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patientsNeurosurgical Review, 2002
- Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrenceJournal of Neurosurgery, 2001
- Treatment of chronic subdural haematoma with burr-hole craniostomy and closed drainage*British Journal of Neurosurgery, 1995
- Chronic Subdural Hematoma in Elderly People: Present Status on Awaji Island and Epidemiological ProspectNeurologia medico-chirurgica, 1992
- The role of endothelial gap junctions in the enlargement of chronic subdural hematomasJournal of Neurosurgery, 1983