“…In these cases, concomitant surgery and hematoma evacuation due to the hematoma mass effect were necessary. It is assumed that this combined treatment could reduce the risk of recurrent hematoma compared to surgery alone [4,14,15]. Our results mirrored these findings, but with 14% of cases showing treatment failure in combined endovascular and surgical treatment versus 22% of cases with surgical treatment alone.…”
Section: Discussionsupporting
confidence: 83%
“…Since Mandai (2000) first described a case of middle meningeal artery (MMA) embolization [11], many studies followed [4,[12][13][14][15]. The main challenge is the correct treatment modality selection; however, the indication criteria for endovascular treatment of CSDHs are not clear.…”
Background: Endovascular treatment of patients with chronic subdural hematoma using middle meningeal artery (MMA) embolization could become an alternative to surgical hematoma evacuation. The aim of the study was to compare methods and identify parameters to help determine the correct treatment modality. Methods: We retrospectively reviewed 142 cases conducted internally; 78 were treated surgically and 64 were treated using MMA embolization. We analyzed the treatment failure rate and complications, and using a binary logistic regression model, we identified treatment failure risk factors. Results: We found a comparable treatment failure rate of 23.1% for the surgery group and 21.9% for the MMA embolization group. However, in the MMA embolization group, 11 cases showed treatment failure due to early neurological worsening with a need for concomitant surgery. We also found a recurrence of hematoma in 15.4% of cases in the surgery group and 6.3% of cases in the MMA embolization group. Conclusion: Both modalities have their advantages; however, correct identification is crucial for treatment success. According to our findings, hematomas with a maximal width of <18 mm, a midline shift of <5 mm, and no acute or subacute (hyperdense) hematoma could be treated with MMA embolization. Hematomas with a maximal width of >18 mm, a midline shift of >5 mm, and no membranous segmentation could have better outcomes after surgical treatment.
“…In these cases, concomitant surgery and hematoma evacuation due to the hematoma mass effect were necessary. It is assumed that this combined treatment could reduce the risk of recurrent hematoma compared to surgery alone [4,14,15]. Our results mirrored these findings, but with 14% of cases showing treatment failure in combined endovascular and surgical treatment versus 22% of cases with surgical treatment alone.…”
Section: Discussionsupporting
confidence: 83%
“…Since Mandai (2000) first described a case of middle meningeal artery (MMA) embolization [11], many studies followed [4,[12][13][14][15]. The main challenge is the correct treatment modality selection; however, the indication criteria for endovascular treatment of CSDHs are not clear.…”
Background: Endovascular treatment of patients with chronic subdural hematoma using middle meningeal artery (MMA) embolization could become an alternative to surgical hematoma evacuation. The aim of the study was to compare methods and identify parameters to help determine the correct treatment modality. Methods: We retrospectively reviewed 142 cases conducted internally; 78 were treated surgically and 64 were treated using MMA embolization. We analyzed the treatment failure rate and complications, and using a binary logistic regression model, we identified treatment failure risk factors. Results: We found a comparable treatment failure rate of 23.1% for the surgery group and 21.9% for the MMA embolization group. However, in the MMA embolization group, 11 cases showed treatment failure due to early neurological worsening with a need for concomitant surgery. We also found a recurrence of hematoma in 15.4% of cases in the surgery group and 6.3% of cases in the MMA embolization group. Conclusion: Both modalities have their advantages; however, correct identification is crucial for treatment success. According to our findings, hematomas with a maximal width of <18 mm, a midline shift of <5 mm, and no acute or subacute (hyperdense) hematoma could be treated with MMA embolization. Hematomas with a maximal width of >18 mm, a midline shift of >5 mm, and no membranous segmentation could have better outcomes after surgical treatment.
“…Ein cSDH kann sich nämlich auch über einen Zeitraum von mehreren Wochen spontan zurückbilden. Alternativ zur chirurgischen Therapie wird in den letzten Jahren auch die Embolisation Embolisation der A. meningea media als endovaskuläre Alternative Endovaskuläre Alternative propagiert, da diese die Rezidivhäufigkeit reduziert [ 24 ].…”
ZusammenfassungDas Schädel-Hirn-Trauma (SHT) bezeichnet eine durch äußere Gewalteinwirkung bedingte Schädigung des Gehirnparenchyms. Es verursacht massive individuelle und sozioökonomische Folgen aufgrund der hohen Morbidität und Mortalität. Betroffen sind junge Menschen durch Verkehrs- oder Sportunfälle, aber auch zunehmend alte Menschen durch Stürze im häuslichen Umfeld. Der Begriff SHT umfasst mehrere Krankheitsbilder, die sich in Ursache, Prognose und Therapie unterscheiden. Allen gemein sind jedoch komplexe pathophysiologische Kaskaden, die sich sofort nach dem initialen Trauma entwickeln und über mehrere Tage und Wochen anhalten können. In dieser Phase versucht eine medizinische Behandlung, sei sie chirurgisch oder medikamentös, die Folgen des Primärschadens zu reduzieren. Die Erhaltung eines adäquaten zerebralen Perfusionsdrucks und die Reduktion des Hirndrucks stehen im Vordergrund.
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