Experience in Endovascular Treatment of Recurrent Chronic Subdural Hematoma

Ishihara, Hideaki; Ishihara, Shoichiro; Kohyama, Shinya; Yamane, Fumitaka; Ogawa, Masazumi; Sato, Akihiro; Matsutani, Masao

doi:10.1177/15910199070130s121

Cited by 81 publications

(57 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For example, a number of groups have reported on the efficacy of middle meningeal artery embolization in the treatment of refractory chronic subdural hematoma [38,53,58,85]. These series have all demonstrated angiography revealing abnormal vascular stains thought to represent formation of neo-capillaries in the subdural membranes.…”

Section: Adjunctive Techniquesmentioning

confidence: 99%

The surgical management of chronic subdural hematoma

et al. 2011

View full text Add to dashboard Cite

Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: "subdural hematoma", "craniotomy", "burr-hole", "management", "anticoagulation", "seizure prophylaxis", "antiplatelet", "mobilization", and "surgical evacuation", alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.

show abstract

Section: Adjunctive Techniquesmentioning

confidence: 99%

The surgical management of chronic subdural hematoma

et al. 2011

View full text Add to dashboard Cite

show abstract

“…4,7,18,[24][25][26] Our series showed a high rate of first (33.3%), second (11.1%), and third recurrences (3.7%), but no reference group of nongeriatric patients with CSDH is available for comparison. Multiple recurrences occurred significantly more often in patients with proven CSF leaks (categories 4 and 5) as compared with patients without such leaks.…”

Section: Patient Profile and Risk Factorsmentioning

confidence: 99%

Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients

Beck¹,

Gralla

Fung³

et al. 2014

JNS

View full text Add to dashboard Cite

Object. The etiology of chronic subdural hematoma (CSDH) in nongeriatric patients (≤ 60 years old) often remains unclear. The primary objective of this study was to identify spinal CSF leaks in young patients, after formulating the hypothesis that spinal CSF leaks are causally related to CSDH.Methods. All consecutive patients 60 years of age or younger who underwent operations for CSDH between September 2009 and April 2011 at Bern University Hospital were included in this prospective cohort study. The patient workup included an extended search for a spinal CSF leak using a systematic algorithm: MRI of the spinal axis with or without intrathecal contrast application, myelography/fluoroscopy, and postmyelography CT. Spinal pathologies were classified according to direct proof of CSF outflow from the intrathecal to the extrathecal space, presence of extrathecal fluid accumulation, presence of spinal meningeal cysts, or no pathological findings. The primary outcome was proof of a CSF leak.Results. Twenty-seven patients, with a mean age of 49.6 ± 9.2 years, underwent operations for CSDH. Hematomas were unilateral in 20 patients and bilateral in 7 patients. In 7 (25.9%) of 27 patients, spinal CSF leakage was proven, in 9 patients (33.3%) spinal meningeal cysts in the cervicothoracic region were found, and 3 patients (11.1%) had spinal cysts in the sacral region. The remaining 8 patients (29.6%) showed no pathological findings.Conclusions. The direct proof of spinal CSF leakage in 25.9% of patients suggests that spinal CSF leaks may be a frequent cause of nongeriatric CSDH. (http://thejns.org/doi/abs/10.3171/2014.6.JNS14550) key WorDS • chronic subdural hematoma • spinal CSF leak • geriatric • vascular disorders • meningeal cyst Abbreviations used in this paper: CSDH = chronic subdural hematoma; mRS = modified Rankin Scale; SIH = spontaneous intracranial hypotension; SPACE = sampling perfection with application of optimized contrasts using different flip angle evolutions.

show abstract

“…5,[8][9][10]17 Information about the MMA on MRA performed before intervention may be useful for developing a strategy for embolizing the MMA. During bur-hole drainage surgery, direct coagulation or embolization of the MMA through a bur hole might facilitate shrinkage of the hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…Several cases of effective embolization to prevent the recurrence of refractory CSDHs were reported recently, 5,[8][9][10]17 which also suggests that embolization of the MMA can intercept the blood supply to the outer membrane of the CSDH and stop hematoma enlargement. The MMA might play an important role in the development of a CSDH.…”

Section: Mechanisms Of Mma Enlargement In a Csdhmentioning

confidence: 97%

“…11 Catheter embolization of the MMA was recently reported to be effective for treating recurrent CSDH by intercepting the blood supply to the outer membrane of the CSDH. 5,[8][9][10]17 Conversely, several studies have reported that MMAs observed with MR angiography (MRA) were enlarged in patients with meningioma, in whom the MMA was a feeding artery to the tumor, 13,18 and in patients with moyamoya disease, in whom the MMA was collateral circulation to the occluded arteries. 6,7 Quantitative measurement of MMA diameter with MRA in patients with migraine has also been reported.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Enlargement of the middle meningeal artery on MR angiography in chronic subdural hematoma

Takizawa¹,

Sorimachi²,

Ishizaka³

et al. 2016

JNS

View full text Add to dashboard Cite

obJective The middle meningeal artery (MMA) is suspected to play an important role in the development of chronic subdural hematoma (CSDH). The aim of this study was to clarify whether the MMA was enlarged in patients with CSDHs. Methods The authors retrospectively assessed 55 patients in whom CSDH was diagnosed between 2010 and 2014 and who underwent MR angiography (MRA) after the onset of CSDH. The authors compared MMA diameters between hemispheres with and without CSDHs on MR angiograms. A case-control study was also performed with 55 sex- and age-matched patients with incidental unruptured aneurysms as controls. results In 55 patients with CSDHs, the diameters of the 79 MMAs on the CSDH side were significantly larger than the diameters of the 31 MMAs on the non-CSDH side (p < 0.05). In 24 patients with bilateral CSDHs, no significant difference was found between the MMA diameters on the larger hematoma side and those on the smaller hematoma side. In 13 patients who underwent MRA before the onset of the CSDH, the MMAs on MR angiograms acquired after onset of the CSDH were significantly larger than those on MR angiograms acquired before the CSDH onset (p < 0.05). The diameters of the MMAs in 55 patients with CSDHs were significantly larger than those of the MMAs in the 55 control patients (p < 0.05). coNclusioNs The MMA is enlarged with development of a CSDH. Information about the MMA observed on MRA in patients with CSDHs may be useful in developing a strategy for future treatment of CSDHs.

show abstract

Experience in Endovascular Treatment of Recurrent Chronic Subdural Hematoma

Cited by 81 publications

References 2 publications

The surgical management of chronic subdural hematoma

The surgical management of chronic subdural hematoma

Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients

Enlargement of the middle meningeal artery on MR angiography in chronic subdural hematoma

Contact Info

Product

Resources

About