Extensive Roles and Technical Advances of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Nakagawa, Ichiro; Kotsugi, Masashi; Yokoyama, Shohei; Maeoka, Ryosuke; Tamura, Kentaro; Takeshima, Yukio; Matsuda, Ryosuke; Yamada, Shuichi; Nishimura, Fusanori; PARK, Young-Soo; Nakase, Hiroyuki

doi:10.2176/jns-nmc.2023-0017

Cited by 3 publications

(1 citation statement)

References 77 publications

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“…In addition, middle meningeal artery (MMA) embolization for cSDH has been documented regularly in recent years, and several technological advancements to enhance clinical results have been published [ 4 ]. After MMA embolization, it has been discovered that embolic materials that are farther distant help prevent recurrences [ 4 ]. Abdollahifard et al performed a meta-analysis of 11 studies and 359 patients.…”

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confidence: 99%

Drainage versus no drainage after burr-hole evacuation of chronic subdural hematoma: a systematic review and meta-analysis of 1961 patients

Aljabali,

Sharkawy,

Jaradat

et al. 2023

Neurosurg Rev

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Chronic subdural hematoma (cSDH) is a common neurosurgical condition that can cause severe morbidity and mortality. cSDH recurs after surgical evacuation in 5–30% of patients, but drains may help reduce this risk. We aimed to investigate the effect of drainage versus no drainage on the rates of recurrence and mortality, as well as the clinical outcomes of cSDH. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to June 2022. Using Review Manager software, we reported four primary outcomes as odds ratios (ORs) and confidence intervals (CIs). The meta-analysis included a total of 10 studies with 1961 patients. The use of drainage was found to be significantly more effective than non-drainage in reducing the “mortality rate” (OR = 0.65, 95% CI 0.43 to 0.97; P = 0.04), the “recurrence rate” (OR = 0.39, 95% CI 0.28 to 0.55; P < 0.00001), and occurrence of “gross focal neurological deficit” (OR = 0.58, 95% CI 0.37 to 0.89; P = 0.01). No significant difference was found in the occurrence of a Glasgow Coma Scale score of 15 (OR = 1.21, 95% CI 0.84 to 1.76; P = 0.30). The use of drains after burr-hole irrigation reduces the recurrence, mortality, and gross focal neurological deficit rates of chronic subdural hematomas.

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Section: Introductionmentioning

confidence: 99%

Drainage versus no drainage after burr-hole evacuation of chronic subdural hematoma: a systematic review and meta-analysis of 1961 patients

Aljabali,

Sharkawy,

Jaradat

et al. 2023

Neurosurg Rev

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Relative Cortical Atrophy Index as a Strong Predictor of Recurrence After Surgery for Chronic Subdural Hematoma

Charehsaz,

Vayisoglu,

Uyaniker

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Chronic subdural hematoma (CSDH) presents significant management challenges in neurosurgical practice, with recurrence being a notable postoperative consideration. This study aimed to evaluate the Relative Cortical Atrophy (RCA) Index as a predictor of recurrence after CSDH surgery. METHODS: A retrospective analysis was conducted on 98 patients who underwent surgical evacuation for unilateral CSDH. The RCA Index was calculated using pre- and postoperative cranial imaging, correlating it with patient demographics, hematoma characteristics, and recurrence. Inter-rater reliability among measurements by 4 independent physicians was assessed using the intraclass correlation coefficient (ICC). Correlation and regression analyses were performed to identify the correlation of the RCA Index with other factors and their potential predicting power of CSDH recurrence, respectively. RESULTS: The study population had a mean age of 74.1 (11.9) years, with a 23.5% (23 patients) recurrence rate of CSDH. The ICC analysis showed excellent inter-rater reliability for RCA Index measurements (ICC: 0.998, 95% CI: 0.997-0.998, P < .001). A higher preoperative RCA Index was significantly associated with recurrence (0.215 [0.031] in the recurrent group vs 0.125 [0.034] in the nonrecurrent group, P < .001). The preoperative RCA Index highly correlated with the postoperative RCA Index (Pearson's correlation: 0.918, P < .001), and there was only a small (average: 0.005) but significant increase in the RCA Index of the unaffected hemisphere after surgery (P = .01).The preoperative RCA Index positively correlated with age, preoperative SDH thickness and volume, and recurrence. A RCA Index cutoff value of 0.165 predicted CSDH recurrence with high sensitivity (95.6%) and specificity (93.3%) (area under the curve = 0.97, 95% CI: 0.93-1). CONCLUSION: The RCA Index is a simple yet robust predictor of CSDH recurrence. Incorporating this measure into the preoperative assessment may enhance surgical planning and postoperative management, potentially reducing recurrence rates.

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Impact of Embolisate Penetration, Type, and Technique on Results After Standalone Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Ma,

Hoz,

Doheim

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Middle meningeal artery embolization (MMAE) has emerged as a promising modality for chronic/subacute subdural hematoma treatment; however, consensus regarding embolization technique and embolisate has not been achieved. We thus sought to compare the efficacy of distinct MMAE techniques and embolisate. METHODS: An institutional registry was reviewed to identify patients undergoing standalone MMAE for symptomatic chronic/subacute subdural hematoma. Surgical rescue rate and time preceding 50% hematoma resolution were evaluated across 3 technical groups: aggressive penetration (AP), nonaggressive penetration with proximal coil embolization (NP-PC), and nonaggressive penetration alone (NP). Effect sizes were adjusted for demographic, neurological and radiological features through multivariable logistic and Cox regression. RESULTS: Among 117 procedures, 33.3% achieved AP, 36.8% had NP-PC, and 29.9% had NP. The rate of surgical rescue was 2.6% after AP, 9.3% for NP-PC, and 11.4% for NP. In patients not undergoing rescue surgery, 82.4% achieved hematoma resolution ≥50% at a median imaging follow-up of 56 days; AP or NP-PC were each statistically significantly associated with enhanced hematoma resolution as compared with NP (P = .02). Similarly, sensitivity analysis within medium-size hematoma and antiplatelet/anticoagulation-at-admission subgroups revealed a superiority of resolution after AP or NP-PC. A unique, comparative secondary analysis of liquid embolisate (Onyx vs n-butyl cyanoacrylate) revealed no impact on rate of surgical rescue or hematoma resolution. CONCLUSION: AP was associated with the lowest rate of surgical rescue, while both AP and NP-PC were associated with improved rates of hematoma resolution.

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Extensive Roles and Technical Advances of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Cited by 3 publications

References 77 publications

Drainage versus no drainage after burr-hole evacuation of chronic subdural hematoma: a systematic review and meta-analysis of 1961 patients

Drainage versus no drainage after burr-hole evacuation of chronic subdural hematoma: a systematic review and meta-analysis of 1961 patients

Relative Cortical Atrophy Index as a Strong Predictor of Recurrence After Surgery for Chronic Subdural Hematoma

Impact of Embolisate Penetration, Type, and Technique on Results After Standalone Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

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