Artikel
Middle meningeal artery embolisation as a treatment for chronic subdural haematoma – first single-centre experience
Partikelembolisation der A. meningea media zur Behandlung chronisch subduraler Hämatome – erste Erfahrungen
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Autoren
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Nadja Grübel
- Bezirkskrankenhaus Günzburg, Neurochirurgie, Günzburg, Deutschland
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Bernd Schmitz
- Bezirkskrankenhaus Günzburg, Neuroradiologie, Günzburg, Deutschland
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Michael Braun
- Bezirkskrankenhaus Günzburg, Neuroradiologie, Günzburg, Deutschland
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Christian Rainer Wirtz
- Bezirkskrankenhaus Günzburg, Neurochirurgie, Günzburg, Deutschland
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Andrej Pala
- Bezirkskrankenhaus Günzburg, Neurochirurgie, Günzburg, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Chronic subdural hematoma (cSDH) is a common disease which is increasing in frequency each year due to aging population and the use of anticoagulation and antiplatelet medication. High recurrence rates after operative treatment, cardiovascular and other comorbidities are common in this patient cohort, so that alternative treatment methods might improve outcome in selected cases. We used middle meningeal artery (MMA) embolization for patients with newly diagnosed cSDH who had critical cardiovascular risk factors and were in urgent need for antiplatelet medication as well as for patients with therapy refractory recurrent and symptomatic cSDHs.
Methods: MMA embolization was performed in 10 patients with therapy refractory cSDH or multimorbid patients using angiography, selective microcatheterization of the MMA, and embolization using microspheres (Embozene) different sizes and coils. The outcome was assessed clinically and with individually indicated follow-up cCT imaging. Coronar cCT images were used to measure the thickness of haematomas, hyperdens areas, chronic parts and membranes.
Results: MMA embolization was performed successfully in 10 patients with cSDH. The indications were
- 1.
- treatment for new (not previously treated) cSDH in 3 patients,
- 2.
- recurrent cSDH in 5 Patients, and
- 3.
- prophylactic treatment (soon after surgical evacuation) in 2 patients.
No patient needed additional surgical evacuation after the treatment, and 70 % had a reduction in size >50% of SDH at longest follow-up. Long term follow-up cCT imaging is outstanding. One patient had one new neurological deficit (abducens paresis) after MMA which was recurrent after long-term follow up. 60% were treated with MMA embolization under anticoagulation.
Conclusion: MMA embolization may represent a minimally-invasive alternative or additional procedure to surgery for new or recurrent chronic SDH, especially in patients with a high risk cardiovascular profile or when cardiovascular disease does not allow pausing anticoagulation. Additionally, patients with therapy refractory recurrent and symptomatic cSDHs could benefit from this procedure.
