Embolization Therapy for Refractory Hemorrhage in Patients with Chronic Subdural Hematomas

Kim, El

doi:10.1016/j.wneu.2017.02.070

Cited by 140 publications

(113 citation statements)

References 30 publications

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“…MMA embolization has been proposed as an endovascular approach to decrease the arterial supply to the vascularized membrane 12. Several recent publications describe the technical aspects and the feasibility of this procedure 13–21. Three populations could potentially benefit from MMA embolization: patients with de novo CSDH requiring initial surgical treatment where MMA embolization could be an adjunctive prophylactic treatment; patients who have failed conservative treatment where MMA embolization could be an alternative to surgery; and patients with recurrent CSDH that has already been surgically treated 22.…”

Section: Introductionmentioning

confidence: 99%

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Derraz

Boetto

et al. 2019

J NeuroIntervent Surg

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BackgroundChronic subdural hematoma (CSDH) is a common condition requiring surgical treatment; however, recurrence occurs in 15% of cases at 1 year. Middle meningeal artery (MMA) embolization has recently emerged as a promising treatment to prevent CSDH recurrence.ObjectiveTo investigate the effect of MMA embolization on hematoma volume resorption (HVR) after surgery in symptomatic patients.MethodsFrom April 2018 to October 2018, participants with CSDH requiring surgery were prospectively randomized in a pilot study, and received either surgical treatment alone (ST group) or surgery and adjuvant MMA embolization (ST+MMAE group). The primary outcome was HVR measured on the 3 month CT scan compared with the immediate pre-embolization CT scan. Secondary outcomes were clinical recurrence of CSDH and safety measures.Results46 patients were randomized and 41 of these achieved a 3 month follow-up . Twenty-one patients received MMA embolization. At 3 months, the HVR from postsurgical level was higher in the ST+MMAE group (mean difference 17.5 mL, 95% CI 3.87 to 31.16 mL; p=0.015). Two participants presented a CSDH recurrence (one in each group). One patient died (ST group). No MMA embolization-related adverse events were reported.ConclusionThe addition of MMA embolization to surgery led to an increase in CSDH resorption at 3 months. One recurrence of CSDH was reported in each group, and there were no treatment-related complications.

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Section: Introductionmentioning

confidence: 99%

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Derraz

Boetto

et al. 2019

J NeuroIntervent Surg

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“…That was similar to non-organized recurrent CSDH. 17) While our 12 cases of OCSDH take longer period to sufficiently decrease the mass effect, and organized components partially remained in four lesions. Therefore, it takes long time to improve neurological deficit, so craniotomy may be required in cases of OCSDH with severe mass effect.…”

Section: Discussionmentioning

confidence: 69%

Efficacy of Middle Meningeal Artery Embolization for Organized Chronic Subdural Hematoma

Izawa

Matsumoto

Nishiyama

et al. 2019

JNET

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This study evaluated the efficacy of middle meningeal artery (MMA) embolization for organized chronic subdural hematoma (OCSDH). Methods: Between 2013 and 2017 at our institution, 11 consecutive patients with 14 OCSDH lesions required MMA embolization, accounting for 4.5% of the 314 patients treated for chronic subdural hematoma (CSDH) in this period. Initially, all lesions underwent burr-hole surgery (BHS) under local anesthesia. At the regrowth, BHS was first performed under local anesthesia. OCSDH was diagnosed based on second-operative findings and postoperative CT or magnetic resonance imaging of the brain, and MMA embolization was performed for OCSDH. We investigated the efficacy of MMA embolization in reducing the hematoma and preventing regrowth of OCSDH. Results: In the second surgery, 12 lesions underwent BHS. Additionally, two lesions were treated with small craniotomy after BHS under local anesthesia. In all lesions, MMA embolization was performed within 3 weeks after the second surgery. In all, 12 lesions improved on brain CT within 2-4 weeks. Two lesions underwent craniotomy and membranectomy under general anesthesia, 2 and 10 days after MMA embolization. In one case, the BHS and small craniotomy were insufficient to reduce the mass effect. In the other case, infectious CSDH was diagnosed at craniotomy. Conclusions: MMA embolization may be effective additional modality for OCSDH after BHS. Keywords▶ organized chronic subdural hematoma, middle meningeal artery, embolization, local anesthesia

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“…Of the 23 treated conventionally, 8 (34.7%) recurred (P=0.024). 40 Interestingly, in both of these case control studies, patients in the embolization arm were more likely to be on antiplatelet medications, and in the Kim et al study were more likely to have bilateral cSDH, in comparison with the conventional treatment arm. Conceivably, both of these variables would be expected to bias the results against the embolization cohort.…”

Section: Middle Meningeal Artery Embolizationmentioning

confidence: 92%

Middle meningeal artery embolization for the management of chronic subdural hematoma

Fiorella

Arthur

2019

J NeuroIntervent Surg

141

125

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Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diagnoses in adults. The disease is fundamentally a disorder of the meningeal blood vessels, and options exist for the minimally invasive neuroendovascular management. We review the potential role for the endovascular management of cSDH within the context of a discussion of the epidemiology, pathophysiology, and conventional management of this disease.

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Embolization Therapy for Refractory Hemorrhage in Patients with Chronic Subdural Hematomas

Cited by 140 publications

References 30 publications

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption

Efficacy of Middle Meningeal Artery Embolization for Organized Chronic Subdural Hematoma

Middle meningeal artery embolization for the management of chronic subdural hematoma

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