Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Series of 60 Cases

Link, Thomas; Knopman, Jared

doi:10.1093/neuros/nyy521

Cited by 180 publications

(171 citation statements)

References 26 publications

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“…This technique was shown to have a high success rate and comparable complication rates to surgical treatment, but results from large studies are still lacking. 16,17 In the future, minimally invasive methods and pharmacological treatments might play a greater role in the treatment of cSDH in geriatric patients presenting with comorbidities and a high perioperative risk. However, to date, surgery (BHD) remains the gold standard treatment for geriatric patients, while we eagerly anticipate results from various prospective studies on pharmacological and other interventional treatment options.…”

Section: Discussionmentioning

confidence: 99%

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Greuter¹,

Lutz

Fandiño

et al. 2020

Neurosurgical Focus

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OBJECTIVEChronic subdural hematoma (cSDH) occurs more frequently in elderly patients, while older patient age is associated with worse postoperative outcome following burr-hole drainage (BHD) of cSDH. The cSDH-Drain trial showed comparable recurrence rates after BHD and placement of either a subperiosteal drain (SPD) or subdural drain (SDD). Additionally, an SPD showed a significantly lower rate of infections as well as iatrogenic parenchymal injuries through drain misplacement. This post hoc analysis aims to compare recurrence rates and clinical outcomes following BHD of cSDH and the placement of SPDs or SDDs in elderly patients.METHODSThe study included 104 patients (47.3%) 80 years of age and older from the 220 patients recruited in the preceding cSDH-Drain trial. SPDs and SDDs were compared with regard to recurrence rate, morbidity, mortality, and clinical outcome. A post hoc analysis using logistic regression, comparing the outcome measurements for patients < 80 and ≥ 80 years old in a univariate analysis and stratified for drain type, was further completed.RESULTSPatients ≥ 80 years of age treated with an SDD showed higher recurrence rates (12.8%) compared with those treated with an SPD (8.2%), without a significant difference (p = 0.46). Significantly higher drain misplacement rates were observed for patients older than 80 years and treated with an SDD compared with an SPD (0% vs 20%, p = 0.01). Comparing patients older than 80 years to younger patients, significantly higher overall mortality (15.4% vs 5.2%, p = 0.012), 30-day mortality (3.8% vs 0%, p = 0.033), and surgical mortality (2.9% vs 1.7%, p = 0.034) rates were observed. Clinical outcome at the 12-month follow-up was significantly worse for patients ≥ 80 years old, and logistic regression showed a significant association of age with outcome, while drain type had no association with outcome.CONCLUSIONSThe initial findings of the cSDH-Drain trial and the findings of this subanalysis suggest that SPD may be warranted in elderly patients. As opposed to drain type, patient age (> 80 years) was significantly associated with worse outcome, as well as higher morbidity and mortality rates.

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Section: Discussionmentioning

confidence: 99%

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Greuter¹,

Lutz

Fandiño

et al. 2020

Neurosurgical Focus

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“…recently reported a 60-patient case series with a 91% long-term success rate. 6 The findings of Ban et al. mirrored the above, with similar complication rates and a positive therapeutic effect with MMA embolization.…”

Section: Discussionmentioning

confidence: 66%

Contrast enhancement of chronic subdural hematomas after embolization of the middle meningeal artery

et al. 2019

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Chronic subdural hematomas are a common neurosurgical presentation. They are difficult to treat, and current interventions – namely surgical evacuation – are not without complications or recurrences. Embolization of the middle meningeal artery is a promising new treatment option for this pathology. We have noted an interesting phenomenon in our patients following endovascular embolization, which is that the subdural hematoma is stained with contrast following the procedure. This ties into the basic physiology of chronic subdurals, which parasitize the middle meningeal artery during the process of membrane formation and neovascularization, which has previously been reported.

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“…The inflammation and bleeding from outer membrane of subdural are caused the recurrencies. 11 Superselective angiography of recurrency subdural hematoma patients show vascular blush along the arterial walls (macrocapillaries). Tempaku 12 reported 5 cases of recurrencies of chronic sbdural hematoma and the results are satisfactory.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Acute Nontraumatic Spontaneous Subdural Haematoma Due to Pseudoaneurysm of Middle Meningeal Artery

Makkiyah

Nurrahmah

2021

MNJ

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Acute subdural bleeding is blood collection in subdural space, usually caused by laceration of the bridging vein that runs from cortex to meningeal layer. On the other hand, the acute epidural hematoma is a collection of blood above the dura mater, usually caused by tearing of the middle meningeal artery. Subdural hematoma acute more likely happen in elderly than young adult. This case report discusses acute spontaneous subdural hematoma that was caused by a pseudoaneurysm of the middle meningeal artery. Seventeen years old boy came with symptoms of high intracranial pressure because of massive subdural bleeding. He was undergone craniotomy. After the clot removal operation, Digital Subtraction Angiography revealed vascular blush and pseudoaneurysm of the middle meningeal artery. Onyx embolization was delivered to proximal to a distal branch of the middle meningeal artery. The patient recovered in good condition, and no rebleeding in two years. Conclusion. Acute spontaneous subdural bleeding even though it is quite rare, but the chance of fatal rebleeding is high. As a result, one still has to look for the source of bleeding and manage comprehensively with embolization.

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Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Series of 60 Cases

Cited by 180 publications

References 26 publications

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Contrast enhancement of chronic subdural hematomas after embolization of the middle meningeal artery

A Case Report of Acute Nontraumatic Spontaneous Subdural Haematoma Due to Pseudoaneurysm of Middle Meningeal Artery

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