Outpatient management of chronic expanding subdural hematomas with endovascular embolization to minimize inpatient admissions during the COVID-19 viral pandemic

Entezami, Pouya; Field, Nicholas C.; Dalfino, John

doi:10.1177/1591019921996510

Cited by 6 publications

(11 citation statements)

References 24 publications

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“…In some cases, MMA embolization was performed as per patients’ preferences. [ 13 ] In the majority of the patients reported in the works by Link and Ban, MMA embolization alone was performed after failure of a conservative management for mildly symptomatic patients. [ 7 , 23 ] In four studies, MMA embolization was proposed in patients under anticoagulant or antiplatelets treatments in order to prevent risk of subdural collection enlargement or to avoid suspension of such medications.…”

Section: Resultsmentioning

confidence: 99%

“…[ 7 , 23 ] In four studies, MMA embolization was proposed in patients under anticoagulant or antiplatelets treatments in order to prevent risk of subdural collection enlargement or to avoid suspension of such medications. [ 13 , 18 , 35 , 52 ] In particular, in 2021, Entezami et al . proposed MMA embolization as an alternative therapy for the management of CSDHs as a day case procedure in the COVID pandemic scenario.…”

Section: Resultsmentioning

confidence: 99%

“…proposed MMA embolization as an alternative therapy for the management of CSDHs as a day case procedure in the COVID pandemic scenario. [ 13 ] Two works did not report the criteria used for selecting patients eligible for MMA embolization but just reported the outcome (e.g. Joyce et al .…”

Section: Resultsmentioning

confidence: 99%

“…From the analysis of the literature, we identified four indications for MMA embolization: To prevent surgery in patients with paucisymptomatic CSDHs,[ 7 , 9 , 13 - 15 , 19 , 20 , 24 , 35 - 37 , 48 , 50 , 51 ] As prophylaxis of a recurrence after a first surgery,[ 5 , 7 , 9 , 14 , 19 , 24 , 34 - 37 , 41 , 42 , 50 ] After a first recurrence to prevent further recurrence,[ 9 , 13 , 17 - 21 , 23 , 24 , 28 , 37 , 43 , 48 , 51 , 54 ] As an adjunctive treatment in case of a second surgery. [ 10 , 17 , 25 , 26 , 28 , 33 , 47 ] …”

Section: Discussionmentioning

confidence: 99%

“…To prevent surgery in patients with paucisymptomatic CSDHs,[ 7 , 9 , 13 - 15 , 19 , 20 , 24 , 35 - 37 , 48 , 50 , 51 ]…”

Section: Discussionmentioning

confidence: 99%

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Middle meningeal artery embolization for chronic subdural hematomas. A systematic review of the literature focused on indications, technical aspects, and future possible perspectives

Cristofori

Remida

Patassini

et al. 2022

Surgical Neurology International

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Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases that affect elderly and fragile patients and as a consequence, management can be challenging. Surgery represents the standard treatment; however, alternative options are under investigation. Middle meningeal artery (MMA) embolization is considered a minimally invasive treatment although with poor evidence. In this review, we tried to summarize the findings about MMA embolization as a treatment for a CSDH to provide a useful guidance for clinical practice and for future speculative aspects. Methods: Literature review on PubMed until March 2021 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. We conducted a research on PubMed with a various combinations of the keywords “CSDH” and “middle meningeal artery” and “embolization,” “refractory subdural hematoma,” and then we reviewed the references of the relevant studies as additional source of eligible articles. Results: Among the 35 studies eligible for this review, 22 were case series, 11 were case reports, one was a technical note, and 1 was a randomized trial. A total of 746 patients were found in the literature. Failure rate of MMA embolization was between 3.9 and 8.9% of the cases according the indication to treat CSDH (upfront vs. after surgery). Conclusion: The global impression deriving from the data available and the literature is that MMA embolization is a safe procedure with very low complications and with a low failure rate, both when associated with surgery or in case of a standalone treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…To prevent surgery in patients with paucisymptomatic CSDHs,[ 7 , 9 , 13 - 15 , 19 , 20 , 24 , 35 - 37 , 48 , 50 , 51 ]…”

Section: Discussionmentioning

confidence: 99%

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Middle meningeal artery embolization for chronic subdural hematomas. A systematic review of the literature focused on indications, technical aspects, and future possible perspectives

Cristofori

Remida

Patassini

et al. 2022

Surgical Neurology International

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Middle Meningeal Artery Embolization in the Management of Chronic Subdural Hematoma: a Comprehensive Review of Current Literature

Désir

Narayan

Ellis

et al. 2023

Curr Neurol Neurosci Rep

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Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques

et al. 2022

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Introduction As we emerge from the current pandemic, hospitals, staff, and resources will need to continue to adjust to meet ongoing healthcare demands. Lessons learned during past shortages can be used to optimize peri-procedural protocols to safely improve the utilization of hospital resources. Methods Retrospective review of patients who underwent elective endovascular intracranial aneurysm treatment was performed. Multivariable logistic regression was used to identify factors associated with patients who were able to be discharged within 24 h of elective procedures. Rates of complications (particularly readmission) were determined. Results 330 patients underwent elective endovascular aneurysm treatment with 86 (26.1%) discharged within 24 h. Factors associated with earlier discharge included procedure years (2019–2021) and male sex. Patients were more likely to be discharged later (after 24 h) if they underwent stent-coil embolization or flow-diversion. There was no association between discharge timing and likelihood of readmission. Discussion Our review highlights the safety of earlier discharge and allowed us to prepare a fast-track protocol for same-day discharge in these patients. This protocol will be studied prospectively in the next phase of this study. As we gain more comfort with emerging, minimally invasive endovascular therapies, we hope to safely achieve same-day discharge on a protocolized and routine basis, reducing the demand of elective aneurysm treatments on our healthcare system. Conclusion We retrospectively demonstrate that early discharge following elective aneurysm treatment is safe in our cohort and provide a fast-track pathway based on these findings for other centers developing similar protocols.

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Outpatient management of chronic expanding subdural hematomas with endovascular embolization to minimize inpatient admissions during the COVID-19 viral pandemic

Cited by 6 publications

References 24 publications

Middle meningeal artery embolization for chronic subdural hematomas. A systematic review of the literature focused on indications, technical aspects, and future possible perspectives

Middle meningeal artery embolization for chronic subdural hematomas. A systematic review of the literature focused on indications, technical aspects, and future possible perspectives

Middle Meningeal Artery Embolization in the Management of Chronic Subdural Hematoma: a Comprehensive Review of Current Literature

Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques

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