Article
Middle meningeal artery embolisation for the treatment of chronic subdural haematomas – a case series
Arteria Meningea Media Embolisation zur Behandlung chronischer Subduralhämatome – eine Fallserie
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Authors
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Charalampos Christoforou
- Helios Klinikum Berlin-Buch, Klinik für Neurochirurgie, Berlin, Deutschland
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Julia Gerhardt
- Helios Klinikum Berlin-Buch, Klinik für Neurochirurgie, Berlin, Deutschland
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Marius Hartmann
- Helios Klinikum Berlin-Buch, Klinik für Neuroradiologie, Berlin, Deutschland
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Yu-Mi Ryang
- Helios Klinikum Berlin-Buch, Klinik für Neurochirurgie, Berlin, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Chronic subdural hematomas (cSDH) represent a common neurosurgical pathology with an incidence of 1.7-20.6 per 100,000 persons per year. Surgical evacuation shows a significant recurrence rate with the need of reevacuation in up to 10-20%. Endovascular middle meningeal artery embolization (MMAE) was recently proposed as a promising stand-alone or adjunct to surgical treatment. This study aims to evaluate the effectiveness and safety of the endovascular embolization of the middle meningeal artery for the treatment of cSDHs.
Methods: From 06/2019 to 08/2020 a total of 26 patients (19 m / 7f; median age 79 (71-85)) with 35 cSDHs (9 bilateral) were treated with MMA embolization. Patients underwent embolization as stand-alone treatment or as adjunct to surgical evacuation either prior to or after surgery. Patients were assessed clinically and with cCT 2 and 6 weeks after the procedure. Primary outcome was absence of significant recurrence with need for surgery. Complete hematoma resolution or significant reduction of more than 50% of its initial size, periprocedural complications and clinical outcome after the modified Rankin Scale (mRS) were secondary outcome parameters.
Results: MMA embolization was successfully performed in all patient with no serious adverse events. 1 Patient (3.8%) presented a hematoma at the inguinal puncture site without need for further treatment. 13 patients received MMAE without surgery, 18 for recurrence after surgical evacuation and 4 in combination with surgical evacuation. From 21/26 patients (80.7%) with 28 cSDHs (80%) follow-up was available for analysis with a median follow-up of 12 weeks (12-15). During follow-up one patient died due to an unrelated cause. From the 28 sufficiently evaluated cSDHs 2 (7.1%) needed surgery for recurrent cSDH after embolization whereas 26 (92.9%) met the primary outcome with 21 (75%) having a complete resolution. The median mRS on admission was 3 (2-4) with mRS at the last follow-up being 1 (0-1).
Conclusion: Data suggest that endovascular embolization of the middle meningeal artery is an effective and safe treatment method for patients with chronic subdural hematoma as a stand-alone procedure or in combination with surgery. Further randomised controlled studies are warranted.
