Article
Efficacy and long-term outcome of middle meningeal artery embolisation for chronic subdural haematoma
DieEffektivität und langfristige Wirkungder Embolisation der Arteria meningea media bei chronischen Subduralhämatomen
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Authors
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Christina Onyinzo
- Schön Klinik Vogtareuth, Neurochirurgie, Vogtareuth, Deutschland
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Manfred Kudernatsch
- Schön Klinik Vogtareuth, Neurochirurgie, Vogtareuth, Deutschland
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Christian Maurer
- Universitätsklinikum Augsburg, Neuroradiologie, Augsburg, Deutschland
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Maria Abel
- Schön Klinik Vogtareuth, Neurochirurgie, Vogtareuth, Deutschland
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Ansgar Berlis
- Universitätsklinikum Augsburg, Neuroradiologie, Augsburg, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Chronic subdural hematoma (CSDH) is a common neurosurgical condition and burr hole irrigation has been the mainstay of treatment. However, with uni- and multimodal treatment options available, consensus on this has not yet been established. Middle meningeal artery (MMA) embolization has recently been proposed as a promising adjunctive or alternative treatment, especially for patients on anticoagulant therapy. This study examined the efficacy and long-term results of MMA as a minimally invasive therapy in patients with CSDH.
Methods: Inclusion criteria in this retrospective study were patients diagnosed with CSDH in our institution between January 2018 and December 2019. They were divided into an embolization or a conventional group based on their treatment approach. The embolization cohort was subdivided into sole embolization treatment and embolization in combination with surgical treatment. Primary outcome was defined as the rate of surgical rescue and secondary outcome as the result at least 3 months after intervention.
Results: Thirty-one MMA embolizations were performed as a sole treatment in 15 patients (48.4%) and combined with burr whole irrigation in 16 patients (51.6%). Thirteen patients (41.9%) were followed-up with a mean follow-up period of 4.3 months. Spontaneous hematoma resolution was seen in 4 patients (30,8%), whereas 8 patients (61.5%) showed a minimal residue without mass effect or any clinical symptoms. Two patients (6.4%) needed hematoma evacuation after sole embolization treatment. Both patients were on anticoagulant therapy. The conventional group included 58 surgical treatments. In this group 38 patients (65.5%) were followed-up with a mean follow-up of 3.4 months. Spontaneous hematoma resolution was seen in 13 patients (43.2%), 20 patients (52.6%) showed a minimal residual hematoma without mass effect. In total, seven patients (12.1%) underwent a surgical rescue after the initial surgery, two patients because of an acute rebleeding during the hospitalization period and five patients due to hematoma reaccumulation with mass effect during the follow-up period. Five of these patients (71.4%) were on anticoagulant treatment.
Conclusion: MMA embolization has a positive therapeutic effect on CSDH, especially in patients on anticoagulant therapy. It seems to be more effective than conventional treatment alone, because of a lower complication rate in terms of acute rebleeding and hematoma reaccumulation.
