Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization

Authors

Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Andrew F. Ducruet, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Kavelin Rumalla, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Candice L. Nguyen, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Caleb Rutledge, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Tyler S. Cole, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Jacob F. Baranoski, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Ashutosh P. Jadhav, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Felipe C. Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA neuropub@barrowneuro.org.Follow

Document Type

Article

Abstract

BACKGROUND: Few reports discuss variables associated with improved outcomes after middle meningeal artery (MMA) embolization for chronic subdural hematomas (cSDHs). We analyzed radiographic evidence of cSDH clearance after MMA embolization to elucidate optimal techniques, hematoma clearance rates, and suitable length of follow-up. METHODS: Patients who underwent MMA embolization for cSDH from January 1, 2018 through December 31, 2020 were analyzed. Patient characteristics, demographics, and technical procedural details were examined. Outcomes for cSDHs analyzed included complete or near-complete resolution at 30, 90, and 180 days following embolization. A multivariable logistic regression analysis identified variables predictive of rapid clearance and resolution of hematomas at 90 days. RESULTS: The study cohort comprised 66 patients with 84 treated cSDHs. The mean (SD) cSDH size differed significantly at 30-day (8.8 (4.3) mm), 90-day (3.4 (3.0) mm), and 180-day (1.0 (1.7) mm) follow-up (p<0.001). More cSDHs had complete or near-complete resolution at 180 days (92%, 67/73) than at 90 (63%, 45/72) and 30 days (18%, 15/84) post-embolization (p<0.001). Only distal embolysate penetration was independently associated with rapid clearance (OR 3.9, 95% CI 1.4 to 11.1; p=0.01) and resolution of cSDHs at 90 days (OR 5.0, 95% CI 1.7 to 14.6; p=0.003). CONCLUSION: Although 63% of cSDHs with MMA embolization had complete or near-complete resolution by 90 days post-procedure, 92% reached this stage by 180 days. Therefore, 90-day follow-up may be insufficient to determine the effectiveness of MMA embolization for cSDHs, particularly compared with surgical evacuation alone. Also, distal MMA penetration may be associated with more rapid hematoma clearance.

Medical Subject Headings

Humans; Meningeal Arteries (diagnostic imaging, surgery); Hematoma, Subdural, Chronic (therapy, surgery); Embolization, Therapeutic (methods); Cohort Studies; Hematoma (therapy)

Publication Date

12-1-2022

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

Volume

14

Issue

12

First Page

1279

Last Page

1283

PubMed ID

34872986

Digital Object Identifier (DOI)

10.1136/neurintsurg-2021-018073

Recommended Citation

Catapano, Joshua S.; Ducruet, Andrew F.; Srinivasan, Visish M.; Rumalla, Kavelin; Nguyen, Candice L.; Rutledge, Caleb; Cole, Tyler S.; Baranoski, Jacob F.; Lawton, Michael T.; Jadhav, Ashutosh P.; and Albuquerque, Felipe C., "Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization" (2022). Translational Neuroscience. 2279.
https://scholar.barrowneuro.org/neurobiology/2279