Middle meningeal artery patency after surgical evacuation for chronic subdural hematoma.
Angiography
Chronic subdural hematoma
Middle meningeal artery embolization
Middle meningeal artery patency
Surgical evacuation
Journal
Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181
Informations de publication
Date de publication:
10 Apr 2024
10 Apr 2024
Historique:
received:
11
12
2023
accepted:
30
03
2024
revised:
27
03
2024
medline:
10
4
2024
pubmed:
10
4
2024
entrez:
9
4
2024
Statut:
epublish
Résumé
Chronic subdural hematoma (CSDH) often requires surgical evacuation, but recurrence rates remain high. Middle meningeal artery (MMA) embolization (MMAE) has been proposed as an alternative or adjunct treatment. There is concern that prior surgery might limit patency, access, penetration, and efficacy of MMAE, such that some recent trials excluded patients with prior craniotomy. However, the impact of prior open surgery on MMA patency has not been studied. A retrospective analysis was conducted on patients who underwent MMAE for cSDH (2019-2022), after prior surgical evacuation or not. MMA patency was assessed using a six-point grading scale. Of the 109 MMAEs (84 patients, median age 72 years, 20.2% females), 58.7% were upfront MMAEs, while 41.3% were after prior surgery (20 craniotomies, 25 burr holes). Median hematoma thickness was 14 mm and midline shift 3 mm. Hematoma thickness reduction, surgical rescue, and functional outcome did not differ between MMAE subgroups and were not affected by MMA patency or total area of craniotomy or burr-holes. MMA patency was reduced in the craniotomy group only, specifically in the distal portion of the anterior division (p = 0.005), and correlated with craniotomy area (p < 0.001). MMA remains relatively patent after burr-hole evacuation of cSDH, while craniotomy typically only affects the frontal-distal division. However, MMA patency, evacuation method, and total area do not affect outcomes. These findings support the use of MMAE regardless of prior surgery and may influence future trial inclusion/exclusion criteria. Further studies are needed to optimize the timing and techniques for MMAE in cSDH management.
Sections du résumé
BACKGROUND
BACKGROUND
Chronic subdural hematoma (CSDH) often requires surgical evacuation, but recurrence rates remain high. Middle meningeal artery (MMA) embolization (MMAE) has been proposed as an alternative or adjunct treatment. There is concern that prior surgery might limit patency, access, penetration, and efficacy of MMAE, such that some recent trials excluded patients with prior craniotomy. However, the impact of prior open surgery on MMA patency has not been studied.
METHODS
METHODS
A retrospective analysis was conducted on patients who underwent MMAE for cSDH (2019-2022), after prior surgical evacuation or not. MMA patency was assessed using a six-point grading scale.
RESULTS
RESULTS
Of the 109 MMAEs (84 patients, median age 72 years, 20.2% females), 58.7% were upfront MMAEs, while 41.3% were after prior surgery (20 craniotomies, 25 burr holes). Median hematoma thickness was 14 mm and midline shift 3 mm. Hematoma thickness reduction, surgical rescue, and functional outcome did not differ between MMAE subgroups and were not affected by MMA patency or total area of craniotomy or burr-holes. MMA patency was reduced in the craniotomy group only, specifically in the distal portion of the anterior division (p = 0.005), and correlated with craniotomy area (p < 0.001).
CONCLUSION
CONCLUSIONS
MMA remains relatively patent after burr-hole evacuation of cSDH, while craniotomy typically only affects the frontal-distal division. However, MMA patency, evacuation method, and total area do not affect outcomes. These findings support the use of MMAE regardless of prior surgery and may influence future trial inclusion/exclusion criteria. Further studies are needed to optimize the timing and techniques for MMAE in cSDH management.
Identifiants
pubmed: 38594307
doi: 10.1007/s10143-024-02383-3
pii: 10.1007/s10143-024-02383-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
145Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Liu W, Bakker NA, Groen RJM (2014) Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg 121:665–673
doi: 10.3171/2014.5.JNS132715
pubmed: 24995782
Moshayedi P, Liebeskind DS (2020) Middle meningeal artery embolization in chronic subdural hematoma: implications of pathophysiology in Trial Design. Front Neurol 11:923
doi: 10.3389/fneur.2020.00923
pubmed: 32973670
pmcid: 7481478
Shapiro M, Walker M, Carroll KT, Levitt MR, Raz E, Nossek E, Delavari N, Mir O, Nelson PK (2021) Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization. J Neurointerv Surg 13:471–477
doi: 10.1136/neurintsurg-2020-016798
pubmed: 33632880
Di Cristofori A, Remida P, Patassini M, Piergallini L, Buonanno R, Bruno R, Carrabba G, Pavesi G, Iaccarino C, Giussani CG (2022) Middle meningeal artery embolization for chronic subdural hematomas. A systematic review of the literature focused on indications, technical aspects, and future possible perspectives. Surg Neurol Int 13:94
doi: 10.25259/SNI_911_2021
pubmed: 35399896
pmcid: 8986643
Sattari SA, Yang W, Shahbandi A, Feghali J, Lee RP, Xu R, Jackson C, Gonzalez LF, Tamargo RJ, Huang J, Caplan JM (2023) Middle Meningeal Artery Embolization Versus Conventional Management for Patients With Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis. Neurosurgery
Salah WK, Baker C, Scoville JP, Hunsaker JC, Ogilvy CS, Moore JM, Riina HA, Levy EI, Spiotta AM, Jankowitz BT, Michael Cawley C 3rd, Khalessi AA, Tanweer O, Hanel R, Gross BA, Kuybu O, Hoang AN, Baig AA, Khorasanizadeh MH, Mendez AA, Cortez G, Davies JM, Narayanan S, Howard BM, Lang MJ, Siddiqui AH, Thomas A, Kan P, Burkhardt J-K, Salem MM, Grandhi R (2023) Middle meningeal artery embolization as a perioperative adjunct to surgical evacuation of nonacute subdural hematomas: an multicenter analysis of safety and efficacy. Interv Neuroradiol J Peritherapeutic Neuroradiol Surg Proced Relat Neurosci. ;15910199231162664
Court J, Touchette CJ, Iorio-Morin C, Westwick HJ, Belzile F, Effendi K (2019) Embolization of the Middle meningeal artery in chronic subdural hematoma - A systematic review. Clin Neurol Neurosurg 186:105464
doi: 10.1016/j.clineuro.2019.105464
pubmed: 31600604
Koo TK, Li MY (2016) A Guideline of selecting and reporting Intraclass correlation coefficients for Reliability Research. J Chiropr Med 15:155–163
doi: 10.1016/j.jcm.2016.02.012
pubmed: 27330520
pmcid: 4913118
Fiorella D, Hirsch JA, Arthur AS (2021) Embolization of the middle meningeal artery for the treatment of chronic subdural hematoma: considerations for pragmatic trial design. J Neurointerv Surg 13:295–297
doi: 10.1136/neurintsurg-2021-017458
pubmed: 33674392
Schirmer CM, Siddiqui AH (2019) Commentary: middle meningeal artery embolization for chronic subdural hematoma: a Series of 60 cases. Neurosurgery 85:E1004–E1005
doi: 10.1093/neuros/nyy587
pubmed: 30534978
Rudy RF, Catapano JS, Jadhav AP, Albuquerque FC, Ducruet AF (2023) Middle Meningeal Artery Embolization to Treat Chronic Subdural Hematoma. Stroke Vasc Interv Neurol [Internet]. ;3:e000490. https://doi.org/10.1161/SVIN.122.000490
Salem MM, Kuybu O, Nguyen Hoang A, Baig AA, Khorasanizadeh M, Baker C, Hunsaker JC, Mendez AA, Cortez G, Davies JM, Narayanan S, Cawley CM, Riina HA, Moore JM, Spiotta AM, Khalessi AA, Howard BM, Hanel R, Tanweer O, Levy EI, Grandhi R, Lang MJ, Siddiqui AH, Kan P, Ogilvy CS, Gross BA, Thomas AJ, Jankowitz BT, Burkhardt J-K (2023) Middle meningeal artery embolization for chronic subdural hematoma: predictors of clinical and radiographic failure from 636 embolizations. Radiology. ;222045
Sadasivan C, Dashti N, Marfoglio S, Fiorella D (2023) In vitro comparison of middle meningeal artery embolization with Squid liquid embolic agent and contour polyvinyl alcohol particles. J Neurointerv Surg
Kan P, Maragkos GA, Srivatsan A, Srinivasan V, Johnson J, Burkhardt J-K, Robinson TM, Salem MM, Chen S, Riina HA, Tanweer O, Levy EI, Spiotta AM, Kasab S, Al, Lena J, Gross BA, Cherian J, Cawley CM, Howard BM, Khalessi AA, Pandey AS, Ringer AJ, Hanel R, Ortiz RA, Langer D, Kelly CM, Jankowitz BT, Ogilvy CS, Moore JM, Levitt MR, Binning M, Grandhi R, Siddiq F, Thomas AJ (2021) Middle meningeal artery embolization for chronic subdural hematoma: a Multi-center experience of 154 consecutive embolizations. Neurosurgery 88:268–277
doi: 10.1093/neuros/nyaa379
pubmed: 33026434
Catapano JS, Ducruet AF, Nguyen CL, Baranoski JF, Cole TS, Majmundar N, Wilkinson DA, Fredrickson VL, Cavalcanti DD, Albuquerque FC (2021) Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis. J Neurointerv Surg 13:657–660
doi: 10.1136/neurintsurg-2020-016552
pubmed: 33077579
Samarage HM, Kim WJ, Zarrin D, Goel K, Chin-Hsiu Wang A, Johnson J, Kaneko N, Nour M, Szeder V, Tateshima S, Jahan R, Duckwiler G, Colby GP (2022) The Bright Falx sign-Midline Embolic Penetration is Associated with faster resolution of chronic subdural Hematoma after Middle Meningeal artery embolization: a Case Series. Neurosurgery 91:389–398
doi: 10.1227/neu.0000000000002038
pubmed: 35551167
Khorasanizadeh M, Shutran M, Garcia A, Enriquez-Marulanda A, Moore J, Ogilvy CS, Thomas AJ (2022) Middle meningeal artery embolization for treatment of chronic subdural hematomas: does selection of embolized branches affect outcomes? J Neurosurg. ;1–9
Weinberg JH, Akhter A, Zakeri A, Tanweer O, Zyck S, Tjoumakaris S, Jabbour P, Kan P, Peng J, Youssef P (2023) Middle meningeal artery embolization for membranous versus non-membranous subdural hematomas: a retrospective and multicenter cohort study. World Neurosurg
Chen H, Salem MM, Colasurdo M, Sioutas GS, Khalife J, Kuybu O, Carroll KT, Hoang AN, Baig AA, Salih M, Khorasanizadeh M, Baker C, Mendez Ruiz A, Cortez GM, Abecassis Z, Ruiz Rodríguez JF, Davies JM, Narayanan S, Cawley CM, Riina H, Moore J, Spiotta AM, Khalessi A, Howard BM, Hanel RA, Tanweer O, Tonetti D, Siddiqui AH, Lang M, Levy EI, Jovin TG, Grandhi R, Srinivasan VM, Levitt MR, Ogilvy CS, Jankowitz B, Thomas AJ, Gross BA, Burkhardt JK, Kan P (2023) Standalone middle meningeal artery embolization versus middle meningeal artery embolization with concurrent surgical evacuation for chronic subdural hematomas: a multicenter propensity score matched analysis of clinical and radiographic outcomes. J Neurointerv Surg
Gomez-Paz S, Akamatsu Y, Salem MM, Enriquez-Marulanda A, Robinson TM, Ogilvy CS, Thomas AJ, Moore JM (2021) Upfront middle meningeal artery embolization for treatment of chronic subdural hematomas in patients with or without midline shift. Interv Neuroradiol J Peritherapeutic Neuroradiol Surg Proced Relat Neurosci 27:571–576
Khorasanizadeh M, Chang Y-M, Enriquez-Marulanda A, Mizuhashi S, Salem MM, Gomez-Paz S, Siddiq F, Kan P, Moore J, Ogilvy CS, Thomas AJ (2021) Morphological changes in chronic subdural hematomas following upfront middle meningeal artery embolization: sequence, timing, and association with outcomes. J Neurosurg. ;1–14
Saway BF, Roth W, Salvador CD, Essibayi MA, Porto GBF, Dowlati E, Felbaum DR, Rock M, Withington C, Desai SK, Hassan AE, Tekle WG, Spiotta A (2023) Subdural evacuation port system and middle meningeal artery embolization for chronic subdural hematoma: a multicenter experience. J Neurosurg 139:131–138
pubmed: 36681990
Salih M, Shutran M, Young M, Vega RA, Stippler M, Papavassiliou E, Alterman RL, Thomas A, Taussky P, Moore J, Ogilvy CS (2023) Reduced recurrence of chronic subdural hematomas treated with open surgery followed by middle meningeal artery embolization compared to open surgery alone: a propensity score-matched analysis. J Neurosurg 139:124–130
pubmed: 36681950