Middle meningeal artery embolization associated with reduced chronic subdural hematoma volume and midline shift in the acute postoperative period

Authors

Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Stefan W. Koester, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Sahin Hanalioglu, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Dara S. Farhadi, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Anant Naik, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Joelle N. Hartke, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Osman Tunc, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Ethan A. Winkler, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Steven W. Chang, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Ashutosh P. Jadhav, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Andrew F. Ducruet, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Felipe C. Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA neuropub@barrowneuro.org.

Document Type

Article

Abstract

BACKGROUND: Middle meningeal artery (MMA) embolization for endovascular treatment of chronic subdural hematoma (cSDH) is growing in popularity. cSDH volume and midline shift were analyzed in the immediate postoperative window after MMA embolization. METHODS: A retrospective analysis of cSDHs managed via MMA embolization from January 1, 2018 to March 30, 2021 was performed at a large quaternary center. Pre- and postoperative cSDH volume and midline shift were quantified with CT. Postoperative CT was obtained 12 to 36 hours after embolization. Paired t-tests were used to determine significant reduction. Multivariate analysis was performed using logistic and linear regression for percent improvement from baseline volume. RESULTS: In total, 80 patients underwent MMA embolization for 98 cSDHs during the study period. The mean (SD) initial cSDH volume was 66.54 (34.67) mL, and the mean midline shift was 3.79 (2.85) mm. There were significant reductions in mean cSDH volume (12.1 mL, 95% CI 9.32 to 14.27 mL, P<0.001) and midline shift (0.80 mm, 95% CI 0.24 to 1.36 mm, P<0.001). In the immediate postoperative period, 22% (14/65) of patients had a>30% reduction in cSDH volume. A multivariate analysis of 36 patients found that preoperative antiplatelet and anticoagulation use was significantly associated with an expansion in volume (OR 0.028, 95% CI 0.000 to 0.405, P=0.03). CONCLUSION: MMA embolization is safe and effective for the management of cSDH and is associated with significant reductions in hematoma volume and midline shift in the immediate postoperative period.

Medical Subject Headings

Humans; Hematoma, Subdural, Chronic (therapy, diagnostic imaging, surgery); Embolization, Therapeutic (methods); Male; Female; Aged; Retrospective Studies; Meningeal Arteries (diagnostic imaging); Middle Aged; Aged, 80 and over; Postoperative Period; Tomography, X-Ray Computed; Treatment Outcome

Publication Date

4-23-2024

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

Volume

16

Issue

5

First Page

478

Last Page

481

PubMed ID

37321836

Digital Object Identifier (DOI)

10.1136/jnis-2022-020054

Recommended Citation

Catapano, Joshua S.; Koester, Stefan W.; Hanalioglu, Sahin; Farhadi, Dara S.; Naik, Anant; Hartke, Joelle N.; Tunc, Osman; Winkler, Ethan A.; Chang, Steven W.; Lawton, Michael T.; Jadhav, Ashutosh P.; Ducruet, Andrew F.; and Albuquerque, Felipe C., "Middle meningeal artery embolization associated with reduced chronic subdural hematoma volume and midline shift in the acute postoperative period" (2024). Neurosurgery. 2014.
https://scholar.barrowneuro.org/neurosurgery/2014