Middle meningeal artery embolization of septated chronic subdural hematomas

被引：1

作者：

Martinez-Gutierrez, Juan Carlos ^{[1
,4
]}

D'Amato, Salvatore A. ^{[1
]}

Zeineddine, Hussein A. ^{[1
]}

Nahhas, Michael, I ^{[1
]}

Kole, Matthew J. ^{[1
]}

Kim, Hyun Woo ^{[1
]}

Kim, Youngran ^{[2
]}

Dawes, Bryden H. ^{[1
]}

Chen, Peng Roc ^{[1
]}

Blackburn, Spiros L. ^{[1
]}

Sheth, Sunil A. ^{[3
]}

Spiegel, Gary ^{[1
]}

Chen, Ching-Jen ^{[1
]}

Mahapatra, Ashutosh ^{[1
,3
]}

Kitagawa, Ryan S. ^{[1
]}

Dannenbaum, Mark J. ^{[1
]}

机构：

[1] Univ Texas Hlth Sci Ctr Houston, Dept Neurosurg, Houston, TX USA

[2] Univ Texas Hlth Sci Ctr Houston, Sch Publ Hlth, Div Management Policy & Community Hlth, Houston, TX USA

[3] Univ Texas Hlth Sci Ctr Houston, Dept Neurol, Houston, TX USA

[4] UTHealth McGovern Med Sch, Dept Neurosurg, 6400 Fannin St Suite 2800, Houston, TX 77030 USA

来源：

INTERVENTIONAL NEURORADIOLOGY | 2023年

关键词：

Subdural hemorrhage; embolization; endovascular therapy; RECURRENCE;

D O I：

10.1177/15910199231184521

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Introduction Middle meningeal artery embolization (MMAE) has emerged as a promising new treatment for patients with chronic subdural hematomas (cSDH). Its efficacy, however, upon the subtype with a high rate of recurrence-septated cSDH-remains undetermined. Methods From our prospective registry of patients with cSDH treated with MMAE, we classified patients based on the presence or absence of septations. The primary outcome was the rate of recurrence of cSDH. Secondary outcomes included a reduction in cSDH thickness, midline shift, and rate of reoperation. Results Among 80 patients with 99 cSDHs, the median age was 68 years (IQR 59-77) with 20% females. Twenty-eight cSDHs (35%) had septations identified on imaging. Surgical evacuation with burr holes was performed in 45% and craniotomy in 18.8%. Baseline characteristics between no-septations (no-SEP) and septations (SEP) groups were similar except for median age (SEP vs no-SEP, 72.5 vs. 65.5, p = 0.016). The recurrence rate was lower in the SEP group (SEP vs. no-SEP, 3 vs. 16.7%, p = 0.017) with higher odds of response from MMAE for septated lesions even when controlling for evacuation strategy and antithrombotic use (OR = 0.06, CI [0.006-0.536], p = 0.012). MMAE resulted in higher mean absolute thickness reduction (SEP vs. no-SEP, -8.2 vs. -4.8 mm, p = 0.016) with a similar midline shift change. The rate of reoperation did not differ (6.2 vs. 3.1%, p = 0.65). Conclusion MMAE appears to be equal to potentially more effective in preventing the recurrence of cSDH in septated lesions. These findings may aid in patient selection.

引用

页数：6

共 18 条

[1] Common data elements reported on middle meningeal artery embolization in chronic subdural hematoma: an interactive systematic review of recent trials [J].