Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Catapano, Joshua S; Nguyen, Candice; Wakim, Andre A; Albuquerque, Felipe C.; Ducruet, Andrew F.

doi:10.3389/fneur.2020.557233

Cited by 67 publications

(61 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Embolization was conducted either in isolation, in combination with surgical intervention or with drugs. Also, different embolization agents, extent of penetration, patient selection, timing of embolization and number of MMA branches embolized were used in the different studies (Catapano et al, 2020(Catapano et al, , 2021a. Moreover, symptoms and neurological deficits from CSDH arise most often due to the mass effect of the subdural collection.…”

Section: Discussionmentioning

confidence: 99%

“…Rupture of these neo-vessels may further enlarge the hematoma ( Takizawa et al, 2016 ). Hence, eliminating the blood supply to the outer neomembrane by embolization of the MMA (eMMA) has been proposed as a minimally invasive treatment for CSDH ( Ban et al, 2018 ; Catapano et al, 2020 , 2021a , 2021b ). And several systematic reviews and a meta-analysis have shown promising results with MMA embolization, including low rates of complication and recurrence ( Haldrup et al, 2020 ; Ironside et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors for Atorvastatin as a Monotherapy for Chronic Subdural Hematoma: A Retrospective Multifactor Analysis

Zhang

Wang

Tian

et al. 2021

Front. Aging Neurosci.

View full text Add to dashboard Cite

Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage in the aging population. We aimed to investigate the predictive factors for atorvastatin efficacy as a monotherapy for moderate CSDH. We retrospectively reviewed the medical records of patients who were diagnosed with moderate CSDH and received atorvastatin monotherapy between February 5, 2014, and November 7, 2015, in multiple neurosurgical departments. Univariate, multivariate and receiver operating characteristic curve analyses were performed to identify the potential significant factors indicative of the good therapeutic efficacy or poor therapeutic efficacy of atorvastatin for mild CSDH, such as age, sex, history of injury, Markwalder grading scale–Glasgow Coma Scale (MGS-GCS), Activities of Daily Life-the Barthel Index scale (ADL-BI), American Society of Anesthesiologists Physical Status classification system (ASA-PS), blood cell counts, serum levels and computed tomography findings. A total of 89 patients (75 men and 14 women) aged 24–88 years (mean age 61.95 ± 15.30 years) were followed-up for 24 weeks. Computed tomography findings at admission showed mixed-density hematoma in 22 patients, isodense hematoma in 13 patients, high-density hematoma in 26 patients, and low-density hematoma in 28 patients. In total, 3, 80, and 6 patients had MGS-GCS grades of 0, 1, and 2, respectively. The efficacy rate at 6 months was 87.6% (78/89). Eleven patients were switched to surgery due to a worsened neurological condition, of whom 8, 1, 1, and 1 had high-density, low-density, isodense and mixed-density hematomas, respectively. These patients were switched to surgery over a range of 2–27 days, with a median interval of 12 days after the medication treatment. Univariate and multivariate analyses, confirmed by ROC curves, revealed that high-density hematoma, basal cistern compression, and hematoma volume to be independent risk factors for the efficacy of atorvastatin monotherapy in patients with moderate CSDH. Atorvastatin is an effective monotherapy for the treatment of mild CSDH. High-density hematoma, basal cistern compression, and hematoma volume are independent predictors of the efficacy of atorvastatin as a non-surgical treatment. The results suggested that ADL-BI was more sensitive than the MGS-GCS and ASA-PS for determining patient outcomes in our moderate CSDH cohort.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk Factors for Atorvastatin as a Monotherapy for Chronic Subdural Hematoma: A Retrospective Multifactor Analysis

Zhang

Wang

Tian

et al. 2021

Front. Aging Neurosci.

View full text Add to dashboard Cite

show abstract

“…[ 2 , 5 ] Although surgical evacuation through burr holes or conventional craniotomy remains the treatment of choice for large symptomatic CSDH, embolization of the middle meningeal artery (MMA) is emerging as an increasingly common treatment strategy. [ 3 , 12 ] Dural arteriovenous fistulas (DAVFs) are abnormal shunts between dural arteries and venous sinuses. Venous sinus thrombosis, prior surgery, and trauma[ 7 , 9 , 10 ] have all been implicated in DAVF formation, presumably through inflammatory and neoangiogenic-mediated recanalization of extant arteriovenous anastomoses.…”

Section: Introductionmentioning

confidence: 99%

Incidentally discovered dural arteriovenous fistula during middle meningeal artery embolization for the treatment of chronic subdural hematoma

Tabibian¹,

Liptrap²,

Jones³

2021

Surgical Neurology International

View full text Add to dashboard Cite

Background: The incidence of chronic subdural hematoma (CSDH) is increasing with population age and anticoagulant use. Embolization of the middle meningeal artery (MMA) is an emerging, less invasive alternative to open surgery in treating this condition. Dural arteriovenous fistula (DAVF) is a rare condition whose association with CSDH is not well understood. We present three cases with incidentally discovered DAVFs during MMA embolization for the treatment of CSDH that necessitated adjustments to initial treatment strategy. Case Descriptions: We retrospectively reviewed all MMA embolizations performed for the treatment of CSDH beginning in 9/2019 to 11/2020. Imaging and hospital course of three cases of incidentally discovered DAVF, including patient demographics, clinical presentation, methods of treatment, imaging and outcome were assessed. Thirty MMA embolizations were performed as primary or adjunct treatment of CSDH. DAVF was discovered angiographically in 3 (10%) cases. All patients reported a history of prior closed head injury, although the timing of injury and subdural blood product age did not correlate in 2 of the 3 cases. All subjects experienced complete symptomatic and radiographic resolution of the subdural hematoma and DAVF following intervention. Conclusion: As MMA embolization for CSDH becomes more frequent, so may the incidental diagnosis of DAVF. Awareness of this potential association is critical to diagnosing DAVF with angiography and altering treatment strategies as needed.

show abstract

“…However, there is no definite conclusion about the effect of propofol on the brain. Studies suggested that propofol can cause forgetting and even lead to impaired memory function [8]. However, there is also a view that propofol has no effect on the learning ability and memory function of experimental animals.…”

Section: Introductionmentioning

confidence: 99%

Imaging Features of Artificial Intelligence Algorithm in the Analysis of Cerebral Protective Effect of Craniotomy Hematoma Removal under Propofol Anesthesia in Patients with Chronic Subdural Hematoma

Bai

Zhao

et al. 2021

Scientific Programming

View full text Add to dashboard Cite

Objective. The aim of this work was to study the cerebral protective effect of craniotomy hematoma removal under propofol anesthesia based on the artificial intelligence algorithm analysis of the changes in imaging characteristics of chronic subdural hematoma (CSDH) patients. Methods. A total of 60 CSDH patients who were treated in hospital were recruited and were randomly rolled into an experimental group and a control group, with 30 people in each group. Patients in the experimental group were treated with propofol anesthesia + craniotomy hematoma removal, while those in the control group were treated with conventional anesthesia + craniotomy hematoma removal. Head CT examinations were performed on the next day, one week, one month, three months, and six months after the operation. A two-dimensional empirical mode decomposition (BEMD) algorithm was used for edge detection and denoising of brain CT images of CSDH patients. Then, the amount of hematoma was calculated, and the Markwalder grading was performed to evaluate the neurological function. The number of recurrence and reoperation cases within six months of follow-up was collected. Results. 1. The quality of CT images was remarkably improved after processing with artificial intelligence algorithms. 2. The amount of hematoma in the experimental group was remarkably lower than that in the control group at January, March, and June after surgery (12.89 ± 2.12 VS 20.32 ± 16.41; 7.55 ± 4.13 VS 15.88 ± 14.22; 3.39 ± 3.79 VS 6.55 ± 3.69, P < 0.05 ). 3. The experimental group was remarkably better than the control group in Markwalder grading three months and six months after the operation ( P < 0.05 ). Conclusion. Artificial intelligence algorithm had good effect on the brain CT image processing of CSDH patients, and craniotomy hematoma removal under propofol anesthesia had an ideal brain protection effect.

show abstract

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Cited by 67 publications

References 52 publications

Risk Factors for Atorvastatin as a Monotherapy for Chronic Subdural Hematoma: A Retrospective Multifactor Analysis

Risk Factors for Atorvastatin as a Monotherapy for Chronic Subdural Hematoma: A Retrospective Multifactor Analysis

Incidentally discovered dural arteriovenous fistula during middle meningeal artery embolization for the treatment of chronic subdural hematoma

Imaging Features of Artificial Intelligence Algorithm in the Analysis of Cerebral Protective Effect of Craniotomy Hematoma Removal under Propofol Anesthesia in Patients with Chronic Subdural Hematoma

Contact Info

Product

Resources

About