Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma

Abstract

BackgroundEmbolization of the middle meningeal artery (MMA) has emerged as a potential treatment of chronic subdural hematomas (CSDHs).ObjectiveTo evaluate the impact on recurrence rate of postsurgical embolization of CSDH in patients with a higher than average risk of recurrence.MethodsA monocentric retrospective study was performed on retrospectively collected data. From March 2018 to December 2019, embolization of the MMA was proposed as an adjunct postoperative treatment after burr-hole surgery in patients operated for a recurrent CSDH or a CSDH with an independent recurrence risk factor, including antiplatelet therapy, full anticoagulation therapy, coagulation disorder, hepatopathy, or chronic alcoholism. Patients who had undergone postoperative embolization were compared with a historic group of patients operated between March 2016 and March 2018, selected based on the same inclusion criteria.ResultsDuring the study period, 89 patients (with 74 unilateral and 15 bilateral CSDHs) were included and underwent an embolization procedure, leading to 91 out of a total of 104 MMA being embolized (88%). These were compared with 174 patients (138 unilateral and 36 bilateral CSDH) in the historic control group. One major procedure-related adverse event was registered. Four of the 89 patients (4%) required surgery for a CSDH recurrence in the embolization group, significantly less than the 24 of 174 patients (14%) in the control group (OR=0.28, 95% CI 0.07 to 0.86, p=0.02).ConclusionsPostsurgical embolization of the MMA may reduce the recurrence rate of CSDHs with a risk factor of recurrence.

Risk of recurrence of subdural hematoma after EMMA vs surgical drainage – Systematic review and meta-analysis

“…These were the only studies that reported a control group where patients underwent surgical drainage for their CSDH. [11][12][13][14] The details of these studies are given in the Table 1. The studies were conducted in Korea 11,12 and France.…”

“…The studies were conducted in Korea 11,12 and France. 13,14 Quality of evidence Quality of evidence was generally low. All the studies included had a mixed prospective intervention group and retrospective historical control group with one randomized control trial.…”

“…Ban et al 12 did not report any mortalities. Shotar et al 13 reported mortalities in 6 out of 89 in EMMA group and 12 out of 174 in the surgical drainage group within the follow-up period. In the EMMA group 3 deaths were CSDH related (multiorgan failure post puncture site thrombosis, contralateral SDH, status epilepticus) while 3 were unrelated (cardiac arrest, neoplasm, undetermined).…”

Trans-cell Approach through Closed-cell Stent for Middle Meningeal Artery Embolization in Recurrent Chronic Subdural Hematoma

“… 7 – 10) In a previous study, 4 of the 89 patients (4%) in the MMAE group required burr hole surgery for CSDH recurrence, significantly less than the 24 of the 174 patients (14%) in the control group ( P = 0.02, odds ratio: 95% confidence interval 0.28: 0.07–0.86). 9) Exponential increases in utilization of MMAE for CSDH treatment in recent years in USA. 11) In Japan, the number of carotid artery angioplasty with stenting (CAS) procedures exceeds that of carotid endarterectomy procedures.…”

Middle Meningeal Artery Embolization and the Treatment of a Chronic Subdural Hematoma

“…There was also a significant improvement in neurological disability scores, as measured by the modified Rankin scale. Similarly, Shotar et al found that postsurgical embolization of the MMA reduced the recurrence rate of cSDH from 14% to 4% [ 37 ].…”