Letter: Middle Meningeal Artery Embolization Versus Conventional Treatment of Chronic Subdural Hematomas

Abstract

embolization vs conventional surgical evacuation that use standardized research methodologies. A team of expert neurosurgeons and neuroradiologists in the field of middle meningeal artery embolization should make consensus recommendations for a standardized study methodology that includes clearly defined inclusion criteria, detailed patients' angiographic baseline anatomy with special focus on angiographic anatomic variants, standardized neurointerventional techniques, standardized embolization material, standardized imaging modalities at baseline and follow-up, and standardized reliable patientcentered tools for clinical evaluation of their neurological deficits such as MMSE.

In Reply: Middle Meningeal Artery Embolization Versus Conventional Treatment of Chronic Subdural Hematomas

“…We agree with Al-Salihi et al 1 that future studies should include patient-centered outcomes such as time-to-restart anticoagulation/antiplatelet therapy. Furthermore, exploring the use of neurocognitive assessment tools could provide additional benefits when evaluating long-term benefits among these patients; the cerebrovascular community should embrace these recommendations to guide our conversations with patients about the benefits that this minimally invasive procedure offers.…”

“…We appreciate and thank the interesting thoughts by Al-Salihi et al 1 on our recently published article. 2 We concur with Al-Salihi et al 1 that definitive recommendations and guidance regarding the benefits of middle meningeal artery embolization (MMAE) in patients with chronic subdural hematomas are currently limited by the heterogeneity (in both patient and outcome data points) found in case series published so far in the current literature. However, our propensity-matched analysis purpose was to provide an approximation to the effect of MMAE by addressing some of these limitations.…”

“…We agree that randomized trials will ultimately address more comprehensively these limitations by eliminating unobserved cofounders and will help extrapolate results and guide patient care. Some of the concerns posted by Al-Salihi et al 1 in this Letter to the Editor are highlighted in our article's limitation and generalizability section, such as the limited attribution of resolution of hematoma after MMAE in the setting of an uncertain natural course of chronic subdural hematomas (cSDH). Details such as lack of homogeneity in group comparisons and procedures limited to high-volume specialized centers are set to improve with wider acceptance through evidence-based conclusions supporting the use of this treatment.…”

“…Regarding the comment by Al-Salihi et al 1 on potential challenges and limitations, one of the primary considerations for adequate patient selection is to make sure that there are no dangerous anastomoses because the anatomy of the middle meningeal artery (MMA) has shown to be variable. Therefore, supraselective MMA angiography is necessary for safe characterization of the target vasculature, including internal carotid artery injections to detect the origin of the ophthalmic artery.…”

Letter: Middle Meningeal Artery Embolization in Adjunction to Surgical Evacuation for Treatment of Subdural Hematomas: A Nationwide Comparison of Outcomes With Isolated Surgical Evacuation

“…The current retrospective evidence available demonstrates promising results associated with MMAE for cSDH, either as a primary or adjunctive treatment. [2][3][4] The study published by Khorasanizadeh et al 1 presents arguable evidence with both limitations and strengths, as discussed by the authors. The large sample size highlights the high efficacy of MMAE-adjunctive surgical evacuation in reducing recurrence and readmission rates by almost half compared with isolated surgical evacuation.…”