Middle Meningeal Artery Embolization Using Combined Particle Embolization and n-BCA with the Dextrose 5% in Water Push Technique for Chronic Subdural Hematomas: A Prospective Safety and Feasibility Study

2021 ◽  
Author(s):  
F. Al-Mufti ◽  
G. Kaur ◽  
K. Amuluru ◽  
J.B. Cooper ◽  
K. Dakay ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Subdural Hematomas ◽  
Meningeal Artery

Morphological changes in chronic subdural hematomas following upfront middle meningeal artery embolization: sequence, timing, and association with outcomes

2021 ◽  
pp. 1-14
Author(s):  
MirHojjat Khorasanizadeh ◽  
Yu-Ming Chang ◽  
Alejandro Enriquez-Marulanda ◽  
Satomi Mizuhashi ◽  
Mohamed M. Salem ◽  
...  
Keyword(s):  
Late Stage ◽  
Morphological Changes ◽  
Prognostic Significance ◽  
Intermediate Stage ◽  
Middle Meningeal Artery ◽  
Structural Features ◽  
Artery Embolization ◽  
Subdural Hematomas ◽  
Meningeal Artery

OBJECTIVE Middle meningeal artery embolization (MMAE) is an increasingly utilized approach for the treatment of chronic subdural hematomas (CSDHs). The course of morphological progression of CSDHs following MMAE is poorly understood. Herein, the authors aimed to describe these morphological changes and assess their prognostic significance for the outcomes on follow-up. METHODS A single-institution retrospective cohort study of CSDH cases treated by upfront MMAE, without prior or adjunctive surgical evacuation, was performed. Clinical outcomes, complications, and the need for rescue surgery on follow-up were recorded. Hematomas were categorized into 6 morphological subtypes. All baseline and follow-up head CT scans were assessed for CSDH structural appearance, density, and loculation. Changes in CSDH size were quantified via 3D reconstruction for volumetric measurement. RESULTS Overall, 52 CSDHs in 45 patients treated with upfront MMAE were identified. Hematomas were followed for a mean of 92.9 days. Volume decreased by ≥ 50% in 79.6% of the CSDHs. The overall rescue surgery rate was 9.6%. A sequence of morphological changes after MMAE was identified. Hematomas that diverged from this sequence (5.4%) all progressed toward treatment failure and required rescue surgery. The CSDHs were categorized into early, intermediate, and late stages based on the baseline morphological appearance. Progression from early to intermediate and then to late stage took 12.7 and 30.0 days, respectively, on average. The volume of early/intermediate- and late-stage hematomas decreased by ≥ 50%, a mean of 78.2 and 47.6 days after MMAE, respectively. Early- and intermediate-stage hematomas showed a trend toward more favorable outcomes compared with late-stage hematomas. The density of homogeneous hypodense hematomas (HSDHs) transiently increased immediately after MMAE (p < 0.001). A marked decrease in density and volume 1 to 3 weeks after MMAE in HSDHs was detected, the lack of which indicated an eventual need for rescue surgery. In HSDHs, a baseline mean density of < 20 HU, and a lower density than baseline by 1 month post-MMAE were predictors of favorable outcomes. The baseline hematoma volume, axial thickness, midline shift, and loculation were not correlated with MMAE outcomes. Loculated, trabecular, and laminar hematomas, which are known to have unfavorable surgical outcomes, had MMAE outcomes similar to those of other "surgical" hematomas. CONCLUSIONS The current study was the first to describe the nature, sequence, and timing of morphological changes of CSDHs after MMAE treatment and has identified structural features that can predict treatment outcomes.

scholarly journals O-026 Clearance of chronic subdural hematomas following middle meningeal artery embolization

2021 ◽  
Author(s):  
J Catapano ◽  
A Ducruet ◽  
K Rumalla ◽  
C Nguyen ◽  
V Srinivasan ◽  
...  
Keyword(s):  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Subdural Hematomas ◽  
Meningeal Artery

scholarly journals The Efficacy and Safety of Middle Meningeal Artery Embolization in the Management of Chronic Subdural Hematomas: Systematic Review and Meta-analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Fareed Jumah ◽  
Muhammad Osama ◽  
Abdurrahman Islim ◽  
Ammar Jumah ◽  
Devi Prasad Patra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Middle Meningeal Artery ◽  
Risk Difference ◽  
Efficacy And Safety ◽  
Weighted Mean ◽  
Artery Embolization ◽  
Subdural Hematomas ◽  
Promising Treatment ◽  
Meningeal Artery

Abstract INTRODUCTION Refractory chronic subdural hematomas (cSDH) constitute a challenging entity that neurosurgeons face frequently nowadays, especially in fragile elderly populations. Middle meningeal artery embolization (MMAE) has emerged in the past years as a promising treatment option. However, solid evidence is still lacking due to paucity of studies and small sample sizes. METHODS We conducted a systematic review and meta-analysis (MA) in compliance with the PRISMA guidelines to evaluate the efficacy and safety of MMAE compared with conventional treatments for refractory or SDH. Four databases were searched up to March 2019. Using a random-effects model, meta-analyses of proportions and risk difference were conducted on outcomes including recurrence, need for surgical rescue, and complications RESULTS A total of 12 studies (177 patients) were included. Majority (69%) were males with weighted mean age of 71 + −19.5 yr. Rate of chronic alcoholism was 15%, cerebral atrophy 39%, use of anticoagulants/antiplatelets 52%, and history of head trauma 55%. Weighted mean hematoma thickness was 17.9 + −13.3 mm. In embolized patients across 12 studies, proportion MA showed rate of treatment failure to be 2.9% (95% CI = 0.5%-5.2%, I2 = 0%), need for surgical rescue 2.7% (95% CI = 0.4%-5%, I2 = 0%), and embolization-related complications 1.2% (95% CI 0.3%-2.7%, I2 = 0%). Meta-analysis of risk-difference between embolized and nonembolized patients in three double-armed cohort studies showed a 26% lower risk of failure in MMAE (95% CI 21%-31%, I2 = 0, Cochran Q = 0.64) that was statistically significant (P < 0.001). Similarly, in the embolized group, the need for surgical rescue was 20% less (95% CI = 12%-27%, I2 = 12.4, Cochran Q = 2.28) and complications 3.6% less (95% CI 1%-6%, I2 = 0, Cochran Q = 0.31) than in conventional groups, both of which achieved statistical significance CONCLUSION Although MMAE appears to be a promising treatment for refractory or cSDH, drawing definitive conclusions remains limited by paucity of data. Large, prospective trials are needed to compare embolization to conventional treatments, like watchful waiting, medical management, or surgical evacuation. More extensive research of MMAE could begin a new era in the minimally invasive management of cSDH.

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