Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Meta-Analysis and Systematic Review

Srivatsan, Aditya; Mohanty, Alina; Nascimento, Fábio A.; Hafeez, Muhammad Ubaid; Srinivasan, Visish M.; Thomas, Ajith J.; Chen, Stephen R.; Johnson, Jeremiah N.

doi:10.1016/j.wneu.2018.11.167

Cited by 149 publications

(122 citation statements)

References 23 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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“…Based on these observations, different approaches were attempted. First, MMA embolization, a novel procedure effective in treating refractory CSH (Srivatsan et al, 2019) was performed, under angiographic control, using polyvinyl alcohol particles, obtaining devascularization of meningeal convexity branches sparing proximal arterial trunks. Second, epidural blood patch (EBP), a mini‐invasive treatment for spontaneous intracranial hypotension, was placed.…”

Section: Reportmentioning

confidence: 99%

Chronic subdural hematoma: A previously unreported life‐threatening complication in adult with Sotos syndrome

Carli¹,

Gazzin²,

Bongioanni

et al. 2020

American J of Med Genetics Pt A

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Macrocephaly, defined as head circumference ≥ 2 SDs, is a cardinal feature of Sotos syndrome (SS) and generally persists in adulthood. Subdural fluid collection, typically associated with macrocephaly, is described in children due to anatomical conformation, and in adulthood due to brain atrophy and ex-vacuo hydrocephalus. On the other hand, a true, symptomatic, chronic subdural hematoma (CSH) is a previously unreported complication of SS in adulthood. Here we describe the first SS patient presenting symptomatic CSH, leading to frequent hospitalizations for surgical evacuations that consistently recurred. Middle meningeal artery (MMA) embolization and epidural blood patch (EBP) allowed to resolve the CSH with complete resolution of clinical signs and symptoms. We hypothesize that appearance and recurrences of CSH may be related to pathological biomechanics of brain, cerebro-spinal fluid and skull, secondary to anatomical features of SS. In this context, surgical evacuation may be less efficient than usual to cure CSH. Alternative treatment to avoid blood extravasation, as MMA embolization, or to cure concurrent causes of the pathology, as EBP, may be considered.

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“…Atorvastatin was effective in reducing the recurrence rate after surgery and promoting the rehabilitation of neurological function (19). Middle meningeal artery embolization combined with craniotomy has arisen as a promising treatment with a significantly lower recurrence rate compared to conventional surgery (20). It is also reported that inserting urokinase into the hematoma can promote clot efflux and show a better outcome.…”

Section: Discussionmentioning

confidence: 99%

Endoscope-Assisted Surgery vs. Burr-Hole Craniostomy for the Treatment of Chronic Subdural Hematoma: A Systemic Review and Meta-Analysis

et al. 2020

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Objectives: This article aims to evaluate the safety and effectiveness of endoscope-assisted surgery for chronic subdural hematoma (cSDH) in comparison with the burr-hole craniostomy. Methods: An electronic literature research was performed in MEDLINE, the Cochrane library, and EMBASE from the inception to February 18, 2020. A systematic review with meta-analyses was conducted to compare the efficacy of endoscope-assisted surgery with Burr-hole Craniostomy (BHC) surgery. Results: This meta-analysis included four studies comprising 441 patients. Endoscope-assisted surgery significantly decreased the risk of recurrence in patients with cSDH [odds ratio, 0.368; 95% confidence interval (CI), 0.178-0.759; P = 0.007; I 2 = 0%]. The complication rate was also significantly lower in the endoscope-assisted group (OR, 0.249; 95% CI, 0.07-0.882; P = 0.031; I 2 = 71.87%). Conclusion: We conducted the first meta-analysis of endoscope-assisted surgery for cSDH. The meta-analysis of four studies comprising 441 patients with cSDH suggests a significantly decreased risk of recurrence and postoperative complications after endoscope-assisted surgery. Therefore, endoscope-assisted surgery is effective and safe in treating cSDH.

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Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Meta-Analysis and Systematic Review

Cited by 149 publications

References 23 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

Chronic subdural hematoma: A previously unreported life‐threatening complication in adult with Sotos syndrome

Endoscope-Assisted Surgery vs. Burr-Hole Craniostomy for the Treatment of Chronic Subdural Hematoma: A Systemic Review and Meta-Analysis

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