Efficacy and mid-term outcome of middle meningeal artery embolization with or without burr hole evacuation for chronic subdural hematoma compared with burr hole evacuation alone

• Published in: Journal of neurointerventional surgery Vol. 14; no. 3; pp. 297 - 300
• Main Authors: Onyinzo, Christina, Berlis, Ansgar, Abel, Maria, Kudernatsch, Manfred, Maurer, Christoph J
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.03.2022; BMJ Publishing Group LTD
• Subjects: Anticoagulants; Aphasia; artery; Catheters; Clinical outcomes; Combined Modality Therapy; complication; Embolization; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Fistula; Hematoma; Hematoma, Subdural, Chronic - diagnostic imaging; Hematoma, Subdural, Chronic - surgery; hemorrhage; Humans; liquid embolic material; Local anesthesia; Meningeal Arteries - diagnostic imaging; Meningeal Arteries - surgery; New devices and techniques; Outpatient care facilities; Patients; Polyvinyl alcohol; Retrospective Studies; subdural; Surgery; Surgical outcomes; Treatment Outcome; Veins & arteries; liquid embolic material; complication; artery; hemorrhage; subdural
• ISSN: 1759-8478; 1759-8486
• DOI: 10.1136/neurintsurg-2021-017450

BackgroundChronic subdural hematoma (CSDH) is a common neurosurgical condition with high recurrence rates. Repeated microbleedings from fragile neo-vessels supplied by peripheral branches of the middle meningeal artery (MMA) are believed to be responsible for the growth and recurrence of CSDH. Thus, MMA embolization might be a promising method to prevent re-bleedings and recurrences. This study aims to assess the efficacy, complication rates, and mid-term outcome of MMA embolization with or without burr hole irrigation compared with burr hole irrigation alone.MethodsPatients diagnosed with CSDH who underwent MMA embolization and/or surgical treatment were retrospectively recruited to this single-center study. The outcome variables were defined as treatment-related complications, clinical outcome at discharge, rate of revision surgery, and CT findings during the follow-up period.ResultsA total of 132 patients with CSDH were included in the study. The use of antiplatelet/anticoagulant medication was significantly higher in the combined treatment and embolization group (p<0.001). A trend towards fewer revision surgeries was found in the group of patients who received MMA embolization combined with burr hole irrigation (p=0.083). Follow-up was available for 73 patients (55.3%) with a mean follow-up period of 3.4±2.2 months. Eight patients (15.1%) of the surgery group showed hematoma re-accumulation and needed surgical rescue, whereas only one patient (5.0%) of the combined treatment group needed revision surgery. In all patients treated with only MMA embolization, complete hematoma resolution was found.ConclusionMMA embolization is a safe and efficacious minimal invasive adjuvant and/or alternative procedure for the treatment of CSDH with a reduced recurrence rate.