Artikel
Efficacy and limitations of the embolisation of the middle meningeal artery in chronic subdural haematoma
Wirksamkeit und Limitationen der Embolisation der A. meningea media bei einem chronischen Subduralhämatom
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Autoren
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Adrian Liebert
- Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinik für Neurochirurgie, Nürnberg, Deutschland
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Heinz-Leonhard Voit-Hoehne
- Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Institut für Radiologie und Nuklearmedizin, Nürnberg, Deutschland
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Leonard Ritter
- Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinik für Neurochirurgie, Nürnberg, Deutschland
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Thomas Eibl
- Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinik für Neurochirurgie, Nürnberg, Deutschland
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Alexander Hammer
- Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinik für Neurochirurgie, Nürnberg, Deutschland
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Hans-Herbert Steiner
- Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinik für Neurochirurgie, Nürnberg, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: The aim of the study is to investigate the efficacy and limitations of the embolization of the middle meningeal artery (MMA) in chronic subdural hematomas (cSDH).
Methods: We retrospectively analyzed patients who underwent embolization of the MMA for the treatment of cSDH from Aug. 2019 to Oct. 2021. The data acquisition included the age of the patients, the radiological appearance (volume, midline shift and Nakaguchi classification), intake of antithrombotic agents and whether it was a recurrent or a primary cSDH. Abnormalities of the MMA and the applied embolic agents were noted.
Statistical analysis was performed with a significance level two-sided p-value of ≤ .05.
Results: Thirty patients with 34 cSDHs underwent embolization. The mean age was 77.5 years (SD=7.6). Seventeen cSDHs were primary and 17 were recurrent or embolized adjuvant to surgery.
According to the Nakaguchi classification, 15 cSDHs appeared homogenous, 6 laminar and 13 trabecular.
Thirteen MMAs were embolized with Onyx, 6 with PHIL, 14 with Squid and one MMA with Onyx and Squid.
Three patients scheduled for embolization possessed a rare variant of the MMA with an origin from the ophthalmic artery, which generally restricts embolization.
The mean volume was 71.1 ml (SD=33) prior to embolization and 35 ml (SD=8.5) in the last follow up (p<.001).
Six cSDHs did not regress in size in the last follow up CT-scan. This leads to an efficacy of 82%. Three of them needed surgery due to worsening of symptoms.
The presence of a contralateral hematoma demonstrated a higher risk of failure of treatment (p=.021).
There was no influence of age (p=.302), pre-interventional volume (p=.635), midline shift (p=.174), history of trauma (p=.327), recurrence (p=.175), the radiological type, presence of new motor deficit (p=.565) or the embolic agent on the radiological outcome.
Three mild complications and one severe complication, permanent visual deficit, occurred.
Conclusion: The embolization of the MMA represents an effective therapy for primary and recurrent cSDHs with an efficacy of 82% in this study. The pre-interventional volume does not seem to influence the outcome whereas the presence of bilateral cSDHs influences it negatively. Ophthalmic origin of the MMA is another limitation of this treatment.
Multicenter prospective randomized controlled trials are necessary to prove efficacy and limitations of the treatment in larger patient cohorts.
