Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma.
Aged
Aged, 80 and over
Embolization, Therapeutic
/ adverse effects
Female
Hematoma, Subdural, Chronic
/ diagnostic imaging
Humans
Male
Meningeal Arteries
/ diagnostic imaging
Middle Aged
Postoperative Complications
/ diagnostic imaging
Plastic Surgery Procedures
/ adverse effects
Recurrence
Retrospective Studies
Risk Factors
chronic subdural hematoma
embolization
middle meningeal artery
recurrence
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
23
03
2020
revised:
22
04
2020
accepted:
25
04
2020
pubmed:
23
5
2020
medline:
9
2
2021
entrez:
23
5
2020
Statut:
ppublish
Résumé
Embolization of the middle meningeal artery (MMA) has emerged as a potential treatment of chronic subdural hematomas (CSDHs). To evaluate the impact on recurrence rate of postsurgical embolization of CSDH in patients with a higher than average risk of recurrence. A monocentric retrospective study was performed on retrospectively collected data. From March 2018 to December 2019, embolization of the MMA was proposed as an adjunct postoperative treatment after burr-hole surgery in patients operated for a recurrent CSDH or a CSDH with an independent recurrence risk factor, including antiplatelet therapy, full anticoagulation therapy, coagulation disorder, hepatopathy, or chronic alcoholism. Patients who had undergone postoperative embolization were compared with a historic group of patients operated between March 2016 and March 2018, selected based on the same inclusion criteria. During the study period, 89 patients (with 74 unilateral and 15 bilateral CSDHs) were included and underwent an embolization procedure, leading to 91 out of a total of 104 MMA being embolized (88%). These were compared with 174 patients (138 unilateral and 36 bilateral CSDH) in the historic control group. One major procedure-related adverse event was registered. Four of the 89 patients (4%) required surgery for a CSDH recurrence in the embolization group, significantly less than the 24 of 174 patients (14%) in the control group (OR=0.28, 95% CI 0.07 to 0.86, p=0.02). Postsurgical embolization of the MMA may reduce the recurrence rate of CSDHs with a risk factor of recurrence.
Sections du résumé
BACKGROUND
BACKGROUND
Embolization of the middle meningeal artery (MMA) has emerged as a potential treatment of chronic subdural hematomas (CSDHs).
OBJECTIVE
OBJECTIVE
To evaluate the impact on recurrence rate of postsurgical embolization of CSDH in patients with a higher than average risk of recurrence.
METHODS
METHODS
A monocentric retrospective study was performed on retrospectively collected data. From March 2018 to December 2019, embolization of the MMA was proposed as an adjunct postoperative treatment after burr-hole surgery in patients operated for a recurrent CSDH or a CSDH with an independent recurrence risk factor, including antiplatelet therapy, full anticoagulation therapy, coagulation disorder, hepatopathy, or chronic alcoholism. Patients who had undergone postoperative embolization were compared with a historic group of patients operated between March 2016 and March 2018, selected based on the same inclusion criteria.
RESULTS
RESULTS
During the study period, 89 patients (with 74 unilateral and 15 bilateral CSDHs) were included and underwent an embolization procedure, leading to 91 out of a total of 104 MMA being embolized (88%). These were compared with 174 patients (138 unilateral and 36 bilateral CSDH) in the historic control group. One major procedure-related adverse event was registered. Four of the 89 patients (4%) required surgery for a CSDH recurrence in the embolization group, significantly less than the 24 of 174 patients (14%) in the control group (OR=0.28, 95% CI 0.07 to 0.86, p=0.02).
CONCLUSIONS
CONCLUSIONS
Postsurgical embolization of the MMA may reduce the recurrence rate of CSDHs with a risk factor of recurrence.
Identifiants
pubmed: 32439812
pii: neurintsurg-2020-016048
doi: 10.1136/neurintsurg-2020-016048
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1209-1213Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: FC reports conflict of interest (unrelated) with Medtronic, Guerbet, Balt Extrusion (payment for readings), Codman Neurovascular (core laboratory). N-AS is consultant for Medtronic, Balt Extrusion, Microvention. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The manuscript is not supported by industry. ES is principal investigator of a randomized controlled trial related to chronic subdural hematomas embolization financed by a PHRC-IR public grant (non-related to the present study).