Embolization of the middle meningeal artery in patients with chronic subdural hematoma—a systematic review and meta-analysis

2020 ◽  
Vol 162 (4) ◽  
pp. 777-784 ◽  
Author(s):  
Mette Haldrup ◽  
Baskaran Ketharanathan ◽  
Birgit Debrabant ◽  
Ole Søndergaard Schwartz ◽  
Ronni Mikkelsen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Meningeal Artery

Middle meningeal artery embolization for chronic subdural hematoma: a systematic review and meta-analysis

2021 ◽  
pp. neurintsurg-2021-017352
Author(s):  
Natasha Ironside ◽  
Candice Nguyen ◽  
Quan Do ◽  
Beatrice Ugiliweneza ◽  
Ching-Jen Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Definitive Treatment ◽  
Complication Rates ◽  
Conventional Management ◽  
Meningeal Artery

Middle meningeal artery (MMA) embolization has been proposed as a minimally invasive treatment for chronic subdural hematoma (cSDH). The aim of this systematic review and meta-analysis is to compare outcomes after MMA embolization versus conventional management for cSDH. We performed a systematic review of PubMed, Embase, Oxford Journal, Cochrane, and Google Scholar databases from April 1987 to October 2020 in accordance with PRISMA guidelines. Studies reporting outcomes after MMA embolization for ≥3 patients with cSDH were included. A meta-analysis comparing MMA embolization with conventional management was performed. The analysis comprised 20 studies with 1416 patients, including 718 and 698 patients in the MMA embolization and conventional management cohorts, respectively. The pooled recurrence, surgical rescue, and in-hospital complication rates in the MMA embolization cohort were 4.8% (95% CI 3.2% to 6.5%), 4.4% (2.8% to 5.9%), and 1.7% (0.8% to 2.6%), respectively. The pooled recurrence, surgical rescue, and in-hospital complication rates in the conventional management cohort were 21.5% (0.6% to 42.4%), 16.4% (5.9% to 27.0%), and 4.9% (2.8% to 7.1%), respectively. Compared with conservative management, MMA embolization was associated with lower rates of cSDH recurrence (OR=0.15 (95% CI 0.03 to 0.75), p=0.02) and surgical rescue (OR=0.21 (0.07 to 0.58), p=0.003). In-hospital complication rates were comparable between the two cohorts (OR=0.78 (0.34 to 1.76), p=0.55). MMA embolization is a promising minimally invasive therapy that may reduce the need for surgical intervention in appropriately selected patients with cSDH. Additional prospective studies are warranted to determine the long-term durability of MMA embolization, refine eligibility criteria, and establish this endovascular approach as a viable definitive treatment for cSDH.

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Meta-Analysis and Systematic Review

2019 ◽  
Vol 122 ◽  
pp. 613-619 ◽  
Author(s):  
Aditya Srivatsan ◽  
Alina Mohanty ◽  
Fábio A. Nascimento ◽  
Muhammad U. Hafeez ◽  
Visish M. Srinivasan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Meningeal Artery

scholarly journals Response to letter regarding: embolization of the middle meningeal artery in patients with chronic subdural hematoma – a review and meta-analysis

2020 ◽  
Vol 162 (9) ◽  
pp. 2031-2031
Author(s):  
Mette Haldrup ◽  
Baskaran Ketharanathan ◽  
Birgit Debrabant ◽  
Ole Søndergaard Schwartz ◽  
Ronni Mikkelsen ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Meningeal Artery

Embolization of the Middle meningeal artery in chronic subdural hematoma — A systematic review

2019 ◽  
Vol 186 ◽  
pp. 105464 ◽  
Author(s):  
Jordan Court ◽  
Charles J Touchette ◽  
Christian Iorio-Morin ◽  
Harrison J. Westwick ◽  
François Belzile ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Meningeal Artery

scholarly journals To drill or not to drill, that is the question: nonsurgical treatment of chronic subdural hematoma in the elderly. A systematic review

2020 ◽  
Vol 49 (4) ◽  
pp. E7
Author(s):  
Alba Scerrati ◽  
Jacopo Visani ◽  
Luca Ricciardi ◽  
Flavia Dones ◽  
Oriela Rustemi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Tranexamic Acid ◽  
Endovascular Treatment ◽  
Subdural Hematoma ◽  
English Language ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Middle Meningeal Artery ◽  
Pharmacological Management ◽  
Meningeal Artery

OBJECTIVEChronic subdural hematoma (CSDH) is one of the most common neurosurgical pathologies, typically affecting the elderly. Its incidence is expected to grow along with the aging population. Surgical drainage represents the treatment of choice; however, postoperative complications and the rate of recurrence are not negligible. For this reason, nonsurgical alternatives (such as middle meningeal artery embolization, steroids, or tranexamic acid administration) are gaining popularity worldwide and need to be carefully evaluated, especially in the elderly population.METHODSThe authors performed a systematic review according to PRISMA criteria of the studies analyzing the nonsurgical strategies for CSDHs. They collected all papers in the English language published between 1990 and 2019 by searching different medical databases. The chosen keywords were “chronic subdural hematoma,” “conservative treatment/management,” “pharmacological treatment,” “non-surgical,” “tranexamic acid,” “dexamethasone,” “corticosteroid,” “glucocorticoid,” “middle meningeal artery,” “endovascular treatment,” and “embolization.”RESULTSThe authors ultimately collected 15 articles regarding the pharmacological management of CSDHs matching the criteria, and 14 papers included the endovascular treatment.CONCLUSIONSThe results showed that surgery still represents the mainstay in cases of symptomatic patients with large CSDHs; however, adjuvant and alternative therapies can be effective and safe in a carefully selected population. Their inclusion in new guidelines is advisable.

scholarly journals Recurrence and Coniglobus Volumetric Resolution of Subacute and Chronic Subdural Hematoma Post-Middle Meningeal Artery Embolization

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 257
Author(s):  
Ambooj Tiwari ◽  
Adam A. Dmytriw ◽  
Ryan Bo ◽  
Nathan Farkas ◽  
Phillip Ye ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Volumetric Analysis ◽  
Primary Therapy ◽  
Curative Therapy ◽  
Complete Obliteration ◽  
Embolization Treatment ◽  
Long Term Follow Up ◽  
Meningeal Artery

Objective: To study the efficacy of middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematoma (SDH) and characterize its post-embolization volumetric resolution. Methods: Ten patients diagnosed with 13 cSDH underwent MMA embolization. SDH volumes were measured from time of initial discovery on imaging to pre-operative, post-operative, short-term and long-term follow-up. Time between procedure to obliteration was also measured. Volumetric analysis was done using the coniglobus formula, and recurrence rate as well as resolution timeline was defined using best-fit models. Results: Out of 10 patients, five were recurrent lesions, three were bilateral and seven unilateral cSDH. Average and median pre-operative volumes were 105.3 cc and 97.4 cc, respectively. Embolization on average was performed 21 days after discovery. Sixty percent of patients had concurrent antiplatelets or anticoagulation use. Forty percent underwent embolization treatment as the primary therapy. Recurrence was not seen in any patients treated with embolization. There were no peri- or post-operative complications. Five patients experienced complete or near-complete obliteration, while those with partial resolution showed a composite average of 75% volumetric reduction in 45 days. Post-embolization, the volumetric resolution followed an exponential decay curve over time and was independent of initial volume. Conclusion: MMA embolization contributed to a marked reduction in SDH volume post-operatively and can be used as a curative therapy for primary or recurrent chronic SDH.

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