Embolization of the Middle meningeal artery in chronic subdural hematoma — A systematic review

Court, Jordan; Touchette, Charles J; Iorio-Morin, Christian; Westwick, Harrison J.; Belzile, François; Effendi, Khaled

doi:10.1016/j.clineuro.2019.105464

Cited by 33 publications

(29 citation statements)

References 44 publications

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“…Recent systematic reviews have corroborated these excellent outcomes. 16,[25][26][27] The hematoma resolution rate was estimated to be as high as 96.8%, 27 with recurrence ranging from 2.1% to 4.1% 16,25,26 and procedural complication rates from 0% to 2.1%. 16,[25][26][27] Surgery for CSDHs in the elderly carries unique challenges regarding effectiveness, recurrence rates, surgical complications, and medical perioperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…16,[25][26][27] The hematoma resolution rate was estimated to be as high as 96.8%, 27 with recurrence ranging from 2.1% to 4.1% 16,25,26 and procedural complication rates from 0% to 2.1%. 16,[25][26][27] Surgery for CSDHs in the elderly carries unique challenges regarding effectiveness, recurrence rates, surgical complications, and medical perioperative complications. 14,[28][29][30][31][32][33][34][35] A 2018 review of adults older than 65 years (2,831,274 cases in the NSQIP registry and 1,952,305 Medicare beneficiaries) found that the rate of postoperative hematoma recurrence requiring repeat surgery was between 5% and 10%.…”

Section: Discussionmentioning

confidence: 99%

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Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Joyce

Bounajem

Scoville

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe incidence of already common chronic subdural hematomas (CSDHs) and other nonacute subdural hematomas (NASHs) in the elderly is expected to rise as the population ages over the coming decades. Surgical management is associated with recurrence and exposes elderly patients to perioperative and operative risks. Middle meningeal artery (MMA) embolization offers the potential for a minimally invasive, less morbid treatment in this age group. The clinical and radiographic outcomes after MMA embolization treatment for NASHs have not been adequately described in elderly patients. In this paper, the authors describe the clinical and radiographic outcomes after 151 cases of MMA embolization for NASHs among 121 elderly patients.METHODSIn a retrospective review of a prospectively maintained database across 15 US academic centers, the authors identified patients aged ≥ 65 years who underwent MMA embolization for the treatment of NASHs between November 2017 and February 2020. Patient demographics, comorbidities, clinical and radiographic factors, treatment factors, and clinical outcomes were abstracted. Subgroup analysis was performed comparing elderly (age 65–79 years) and advanced elderly (age > 80 years) patients.RESULTSMMA embolization was successfully performed in 98% of NASHs (in 148 of 151 cases) in 121 patients. Seventy elderly patients underwent 87 embolization procedures, and 51 advanced elderly patients underwent 64 embolization procedures. Elderly and advanced elderly patients had similar rates of embolization for upfront (46% vs 61%), recurrent (39% vs 33%), and prophylactic (i.e., with concomitant surgical intervention; 15% vs 6%) NASH treatment. Transfemoral access was used in most patients, and the procedure time was approximately 1 hour in both groups. Particle embolization with supplemental coils was most common, used in 51% (44/87) and 44% (28/64) of attempts for the elderly and advanced elderly groups, respectively. NASH thickness decreased significantly from initial thickness to 6 weeks, with additional decrease in thickness observed in both groups at 90 days. At longest follow-up, the treated NASHs had stabilized or improved in 91% and 98% of the elderly and advanced elderly groups, respectively, with > 50% improvement seen in > 60% of patients for each group. Surgical rescue was necessary in 4.6% and 7.8% of cases, and the overall mortality was 8.6% and 3.9% for elderly and advanced elderly patients, respectively.CONCLUSIONSMMA embolization can be used safely and effectively as an alternative or adjunctive minimally invasive treatment for NASHs in elderly and advanced elderly patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Joyce

Bounajem

Scoville

et al. 2020

Neurosurgical Focus

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“…6 13 The notion of subdural hematoma resulting from repetitive, indolent inner layer hemorrhage naturally suggests embolization as a management strategy, first reported by Mandai et al in 2000 17 and more recently highlighted in multiple publications and reviews. [18][19][20][21][22][23][24][25][26][27][28] We may also wonder whether a straightforward procedure such as MMA embolization, with a two decades long trickle of encouraging reports, [29][30][31] would have gained attention sooner had the prevailing idea of bridging vein rupture not been adhered to as devoutly, or had the long existing literature on true pathogenesis been better known in the endovascular community.…”

Section: Introduction General Aspects Of Dural Vascular Anatomy and Pathologymentioning

confidence: 99%

Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization

Shapiro

Walker

Carroll

et al. 2021

J NeuroIntervent Surg

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Adoption of middle meningeal artery embolization in the management of chronic subdural hematomas has led to a renewed interest in dural vascular anatomy. The readily identifiable major dural arteries and potential hazards associated with their embolization are well described. Less emphasized are several levels of intrinsic dural angioarchitecture, despite their more direct relationship to dural based diseases, such as subdural hematoma and dural fistula. Fortunately, microvascular aspects of dural anatomy, previously limited to ex vivo investigations, are becoming increasingly accessible to in vivo visualization, setting the stage for synthesis of the old and the new, and providing a rationale for the endovascular approach to subdural collections in particular. In contrast with traditional anatomical didactics, where descriptions advance from larger trunks to smaller pedicles, we present a strategic approach that proceeds from a fundamental understanding of the dural microvasculature and its relationship to larger vessels.

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“…El HSDc es más frecuentemente en pacientes adultos entre la quinta y séptima décadas de la vida (usualmente en mayores de 65 años), con una incidencia de 58,1 por cada 100.000 personas al año. La incidencia en la población general es de 1 a 5 casos por cada 100.000 personas al año (1,4). Se presenta con mayor frecuencia en el género masculino que en el femenino, en una proporción del 77 %, en comparación con el 23 %, respectivamente (5).…”

Section: Epidemiologíaunclassified

Hematoma subdural crónico. Una actualización y revisión

Vega¹,

Q²

2021

Univ. Med.

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El hematoma subdural crónico es una de las entidades más frecuentes en la práctica médica general y neuroquirúrgica, por lo cual, su diagnóstico y tratamiento mejora el pronóstico de los pacientes. El factor más frecuente implicado para el desarrollo es el trauma, sin embargo, se conocen otros factores como la antigcoagulación, la fragilidad o dependencia funcional total, las comorbilidades, la atrofia cerebral, entre otros. El tratamiento del hematoma subdural crónico es quirúrgico, cuando este esta contraindicado, es recurrente o no esta indicada la intervención quirurgica, se plantean otros tratamientos como el manejo médico y la embolización de la arteria meníngea media, obteniendo gran auje en los últimos años este último. El objetivo del presente articulo es describir los conceptos generales del hematoma subdural crónico, énfasis en el manejo médico actual y la terapia endovascular

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Embolization of the Middle meningeal artery in chronic subdural hematoma — A systematic review

Cited by 33 publications

References 44 publications

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization

Hematoma subdural crónico. Una actualización y revisión

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