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KMID : 1005420230250010028
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Journal of Cerebrovascular and Endovascular Neurosurgery
2023 Volume.25 No. 1 p.28 ~ p.35
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Middle meningeal artery embolization for chronic subdural hematoma in elderly patients at high risk of surgical treatment
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Seok Jin-Hoo
Kim Jong-Hyun
Kwon Taek-Hyun
Byun Joon-Ho
Yoon Won-Ki
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Abstract
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Objective: The purpose of this study was to evaluate the effectiveness of middle meningeal artery embolization (MMAE) in elderly high-risk patients with symptomatic chronic subdural hematoma (CSDH) in terms of reduction in hematoma volume and recurrence rate.
Methods: We retrospectively reviewed data prospectively collected from nine patients who underwent 13 MMAE for CSDH between June 2017 and May 2022. The volume of the subdural hematoma was measured using a computer-aided volumetric analysis program. Hematoma volume changes during the follow-up period were analyzed and clinical outcomes were evaluated.
Results: The mean follow-up period was 160 days (range, 46?311 days). All procedures were technically successful and there were no procedure-related complications. Of the 13 MMAE, 84% (11 out of 13 hemispheres) showed mean 88% of reduction on follow-up volumetric study with eight cases of complete resolution. There was one refractory case with MMAE which had been performed multiple burr-hole trephinations, for which treatment was completed by craniotomy and meticulous resection of multiple pseudomembranes. There was no recurrent case during the follow-up period, except for refractory case.
Conclusions: MMAE for CSDH in selected high-risk elderly patients and relapsed patients might be effective. Despite the small cohort, our findings showed a high rate of complete resolution with no complications. Further prospective randomized trials are warranted to evaluate its usefulness as a primary treatment option for CSDH.
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KEYWORD
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Chronic subdural hematoma, Embolization, Middle meningeal artery, Craniotomy
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