Details

Autor(en) / Beteiligte

• Catapano, Joshua
• Nguyen, Candice
• Baranoski, Jacob F
• Cole, Tyler S
• Majmundar, Neil J
• Wilkinson, D. Andrew
• Fredrickson, Vance
• Cavalcanti, Daniel D
• Ducruet, Andrew F
• Albuquerque, Felipe

Titel

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: An Institutional Analysis

Ist Teil von

• Neurosurgery, 2020-12, Vol.67 (Supplement_1)

Ort / Verlag

Philadelphia: Wolters Kluwer Health, Inc

Erscheinungsjahr

2020

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• INTRODUCTION Chronic subdural hematoma (cSDH) remains of the most common neurological diseases, often causing significant morbidity especially in the elderly population. Recently, middle meningeal artery (MMA) embolization has emerged as a potentially safe and effective method of treating cSDH. METHODS A retrospective analysis of all patients undergoing MMA embolization from January 1st, 2018 to December 31st, 2019 was performed. A failed outcome was defined as either surgical rescue and/or >10 mm of residual or reaccumulation following embolization. Secondary outcomes analyzed included complete resolution of the cSDH and change in cSDH size. RESULTS The 35 patients that met the inclusion criteria had an average age of 68 ± 12years. Headache(N = 14, 40%) and focal neurological deficit(N = 15, 43%) were the most common presenting symptoms. Nine(26%) had failed surgery and 6(17%) had failed initial conservative treatment. Transradial access was utilized in 21 patients(60%). A single ischemic complication(3%) in a patient with a type 3 arch constituted the only long-term complication in this series. Out of a total of 41 MMA embolizations, including 6 patients with bilateral cSDH who underwent bilateral MMA embolization, 29 were performed using Onyx (71%), 7 using particles(17%), and 5 using nBCA(12%). Both the anterior and posterior MMA divisions were embolized in 71% of cases 71%) and distal penetration of these branches was achieved in 61% of embolizations. Twenty-six cSDHs(63%) completely resolved. Of these, complete resolution was seen in 22 hematomas (76% of 29 total) in which both anterior and posterior MMA branches were occluded relative to only 4(33% of 12 total) following single branch embolization(P = .014). Failed embolization was seen in only one cSDH(1%). CONCLUSION Our center's technique of MMA embolization for cSDH has evolved over time. We now favor transradial access for Onyx embolization, which is both safe and efficacious. Furthermore, embolization of both the anterior and posterior MMA branches may be associated with an increase odd of complete resolution. Future randomized control trials and/or large prospective studies are warranted, with attention to optimizing the procedural technique.