gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Correlation between middle meningeal artery embolisation for treatment of chronic subdural haematoma and haematoma volume in patients under anti-platelet therapy

Korrelation zwischen Embolization der Arteria meningea media und Volumen des chronischen Subduralhämatoms in Patienten unter Plättchenaggregationshemmer

Meeting Abstract

  • presenting/speaker Ines Laginha - Universitätsmedizin Göttingen, Göttingen, Deutschland
  • Silvia Hernández-Durán - Universitätsmedizin Göttingen, Göttingen, Deutschland
  • Christian Brelie - Universitätsmedizin Göttingen, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Göttingen, Deutschland
  • Tammam Abboud - Universitätsmedizin Göttingen, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV205

doi: 10.3205/22dgnc199, urn:nbn:de:0183-22dgnc1998

Published: May 25, 2022

© 2022 Laginha et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Chronic subdural hematoma (cSDH) often requires neurosurgical evacuation. The recurrence rates after burr hole craniotomy and twist drill craniostomy (TDC) are high, especially in patients under antiplatelet therapy. Middle meningeal artery embolization (MMAE) has surged as an endovascular intervention, used nowadays either as a stand-alone procedure or as a complementary approach to the neurosurgical evacuation of the cSDH, aiming to reduce the recurrence rate. However, neither the optimal timing for MMAE, nor the safety profile regarding patients taking anti-platelet therapy has been addressed. We had the hypothesis, that MMAE before planned TDC reduces the recurrence rate in a subgroup of patients who received anti-platelet drugs.

Methods: We prospectively collected clinical and radiological data of patients who presented between December 2019 and September 2021 with cSDH and were assigned primarily to a MMAE, as they were under anti-platelet medication. Surgical evacuation (twist drill craniostomy [TDC]) was performed consecutively. Pre- and postinterventional volumetric measurement of hematoma were performed and correlated with clinical course.

Results: Nineteen patients were included in the study. 5 (26,3%) of the 19 patients showed a significant increase in the volume of subdural hematoma immediately after MMAE (mean of differences (volume after MMAE – volume before) = 18.4 ±5.3 cm3; 95% CI= 3.7 to 33.12 cm3; p=0.025). All 5 patients showed a clinical deterioration that ranged from worsening of the hemiparesis to decreasing level of consciousness, which urged a surgical evacuation. The remaining patients showed neither a significant difference in the volume of subdural hematoma nor neurological deterioration after MMAE (mean of differences (after MMAE – before MMAE) = -6.9±3 cm3; 95% CI= -14.74 to 0.9 cm3; p=0.072).

Conclusion: In this small series, we found a significant rate of increase in the volume of cSDH following MMAE, accompanied with clinical deterioration among patients who were under anti-platelet therapy at presentation. Our results suggest the strategy of MMAE as a primary treatment in patients under anti-platelet therapy should be re-evaluated. These results need further verification in larger clinical series.