Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations

Peter Kan; Georgios A. Maragkos; Aditya Srivatsan; Visish Srinivasan; Jeremiah Johnson; Jan Karl Burkhardt; Timothy M. Robinson; Mohamed M. Salem; Stephen Chen; Howard A. Riina; Omar Tanweer; Elad I. Levy; Alejandro M. Spiotta; Sami Al Kasab; Jonathan Lena; Bradley A. Gross; Jacob Cherian; C. Michael Cawley; Brian M. Howard; Alexander A. Khalessi; Aditya S. Pandey; Andrew J. Ringer; Ricardo Hanel; Rafael A. Ortiz; David Langer; Cory M. Kelly; Brian T. Jankowitz; Christopher S. Ogilvy; Justin M. Moore; Michael R. Levitt; Mandy Binning; Ramesh Grandhi; Farhan Siddiq; Ajith J. Thomas

doi:10.1093/neuros/nyaa379

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations

Peter Kan, Georgios A. Maragkos, Aditya Srivatsan, Visish Srinivasan, Jeremiah Johnson, Jan Karl Burkhardt, Timothy M. Robinson, Mohamed M. Salem, Stephen Chen, Howard A. Riina, Omar Tanweer, Elad I. Levy, Alejandro M. Spiotta, Sami Al Kasab, Jonathan Lena, Bradley A. Gross, Jacob Cherian, C. Michael Cawley, Brian M. Howard, Alexander A. KhalessiAditya S. Pandey, Andrew J. Ringer, Ricardo Hanel, Rafael A. Ortiz, David Langer, Cory M. Kelly, Brian T. Jankowitz, Christopher S. Ogilvy, Justin M. Moore, Michael R. Levitt, Mandy Binning, Ramesh Grandhi, Farhan Siddiq, Ajith J. Thomas

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

BACKGROUND: Middle meningeal artery (MMA) embolization has emerged as a promising treatment for chronic subdural hematoma (cSDH). OBJECTIVE: To determine the safety and efficacy of MMA embolization. METHODS: Consecutive patients who underwent MMA embolization for cSDH (primary treatment or recurrence after conventional surgery) at 15 centers were included. Clinical details and follow-up were collected prospectively. Primary clinical and radiographic outcomes were the proportion of patients requiring additional surgical treatment within 90 d after index treatment and proportion with > 50% cSDH thickness reduction on follow-up computed tomography imaging within 90 d. National Institute of Health Stroke Scale and modified Rankin Scale were also clinical outcomes. RESULTS: A total of 138 patients were included (mean age: 69.8, 29% female). A total of 15 patients underwent bilateral interventions for 154 total embolizations (66.7% primary treatment). At presentation, 30.4% and 23.9% of patients were on antiplatelet and anticoagulation therapy, respectively. Median admission cSDH thickness was 14 mm. A total of 46.1% of embolizations were performed under general anesthesia, and 97.4% of procedures were successfully completed. A total of 70.2% of embolizations used particles, and 25.3% used liquid embolics with no significant outcome difference between embolization materials (P >. 05). On last follow-up (mean 94.9 d), median cSDH thickness was 4 mm (71% median thickness reduction). A total of 70.8% of patients had >50% improvement on imaging (31.9% improved clinically), and 9 patients (6.5%) required further cSDH treatment. There were 16 complications with 9 (6.5%) because of continued hematoma expansion. Mortality rate was 4.4%, mostly unrelated to the index procedure but because of underlying comorbidities. CONCLUSION: MMA embolization may provide a safe and efficacious minimally invasive alternative to conventional surgical techniques.

Original language	English (US)
Pages (from-to)	268-277
Number of pages	10
Journal	Neurosurgery
Volume	88
Issue number	2
DOIs	https://doi.org/10.1093/neuros/nyaa379
State	Published - Feb 1 2021
Externally published	Yes

Keywords

Chronic subdural hematoma
Chronic subdural hemorrhage
Middle meningeal artery embolization
Refractory subdural hematoma
Refractory subdural hemorrhage

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1093/neuros/nyaa379

Cite this

Kan, P., Maragkos, G. A., Srivatsan, A., Srinivasan, V., Johnson, J., Burkhardt, J. K., Robinson, T. M., Salem, M. M., Chen, S., Riina, H. A., Tanweer, O., Levy, E. I., Spiotta, A. M., Kasab, S. A., Lena, J., Gross, B. A., Cherian, J., Michael Cawley, C., Howard, B. M., ... Thomas, A. J. (2021). Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations. Neurosurgery, 88(2), 268-277. https://doi.org/10.1093/neuros/nyaa379

Kan, P, Maragkos, GA, Srivatsan, A, Srinivasan, V, Johnson, J, Burkhardt, JK, Robinson, TM, Salem, MM, Chen, S, Riina, HA, Tanweer, O, Levy, EI, Spiotta, AM, Kasab, SA, Lena, J, Gross, BA, Cherian, J, Michael Cawley, C, 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, vol. 88, no. 2, pp. 268-277. https://doi.org/10.1093/neuros/nyaa379

@article{b1d503fa74a94b92bcd12f96b67ff650,

title = "Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations",

abstract = "BACKGROUND: Middle meningeal artery (MMA) embolization has emerged as a promising treatment for chronic subdural hematoma (cSDH). OBJECTIVE: To determine the safety and efficacy of MMA embolization. METHODS: Consecutive patients who underwent MMA embolization for cSDH (primary treatment or recurrence after conventional surgery) at 15 centers were included. Clinical details and follow-up were collected prospectively. Primary clinical and radiographic outcomes were the proportion of patients requiring additional surgical treatment within 90 d after index treatment and proportion with > 50% cSDH thickness reduction on follow-up computed tomography imaging within 90 d. National Institute of Health Stroke Scale and modified Rankin Scale were also clinical outcomes. RESULTS: A total of 138 patients were included (mean age: 69.8, 29% female). A total of 15 patients underwent bilateral interventions for 154 total embolizations (66.7% primary treatment). At presentation, 30.4% and 23.9% of patients were on antiplatelet and anticoagulation therapy, respectively. Median admission cSDH thickness was 14 mm. A total of 46.1% of embolizations were performed under general anesthesia, and 97.4% of procedures were successfully completed. A total of 70.2% of embolizations used particles, and 25.3% used liquid embolics with no significant outcome difference between embolization materials (P >. 05). On last follow-up (mean 94.9 d), median cSDH thickness was 4 mm (71% median thickness reduction). A total of 70.8% of patients had >50% improvement on imaging (31.9% improved clinically), and 9 patients (6.5%) required further cSDH treatment. There were 16 complications with 9 (6.5%) because of continued hematoma expansion. Mortality rate was 4.4%, mostly unrelated to the index procedure but because of underlying comorbidities. CONCLUSION: MMA embolization may provide a safe and efficacious minimally invasive alternative to conventional surgical techniques.",

keywords = "Chronic subdural hematoma, Chronic subdural hemorrhage, Middle meningeal artery embolization, Refractory subdural hematoma, Refractory subdural hemorrhage",

author = "Peter Kan and Maragkos, {Georgios A.} and Aditya Srivatsan and Visish Srinivasan and Jeremiah Johnson and Burkhardt, {Jan Karl} and Robinson, {Timothy M.} and Salem, {Mohamed M.} and Stephen Chen and Riina, {Howard A.} and Omar Tanweer and Levy, {Elad I.} and Spiotta, {Alejandro M.} and Kasab, {Sami Al} and Jonathan Lena and Gross, {Bradley A.} and Jacob Cherian and {Michael Cawley}, C. and Howard, {Brian M.} and Khalessi, {Alexander A.} and Pandey, {Aditya S.} and Ringer, {Andrew J.} and Ricardo Hanel and Ortiz, {Rafael A.} and David Langer and Kelly, {Cory M.} and Jankowitz, {Brian T.} and Ogilvy, {Christopher S.} and Moore, {Justin M.} and Levitt, {Michael R.} and Mandy Binning and Ramesh Grandhi and Farhan Siddiq and Thomas, {Ajith J.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2020 by the Congress of Neurological Surgeons.",

year = "2021",

month = feb,

day = "1",

doi = "10.1093/neuros/nyaa379",

language = "English (US)",

volume = "88",

pages = "268--277",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

TY - JOUR

T1 - Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

T2 - A Multi-Center Experience of 154 Consecutive Embolizations

AU - Kan, Peter

AU - Maragkos, Georgios A.

AU - Srivatsan, Aditya

AU - Srinivasan, Visish

AU - Johnson, Jeremiah

AU - Burkhardt, Jan Karl

AU - Robinson, Timothy M.

AU - Salem, Mohamed M.

AU - Chen, Stephen

AU - Riina, Howard A.

AU - Tanweer, Omar

AU - Levy, Elad I.

AU - Spiotta, Alejandro M.

AU - Kasab, Sami Al

AU - Lena, Jonathan

AU - Gross, Bradley A.

AU - Cherian, Jacob

AU - Michael Cawley, C.

AU - Howard, Brian M.

AU - Khalessi, Alexander A.

AU - Pandey, Aditya S.

AU - Ringer, Andrew J.

AU - Hanel, Ricardo

AU - Ortiz, Rafael A.

AU - Langer, David

AU - Kelly, Cory M.

AU - Jankowitz, Brian T.

AU - Ogilvy, Christopher S.

AU - Moore, Justin M.

AU - Levitt, Michael R.

AU - Binning, Mandy

AU - Grandhi, Ramesh

AU - Siddiq, Farhan

AU - Thomas, Ajith J.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - BACKGROUND: Middle meningeal artery (MMA) embolization has emerged as a promising treatment for chronic subdural hematoma (cSDH). OBJECTIVE: To determine the safety and efficacy of MMA embolization. METHODS: Consecutive patients who underwent MMA embolization for cSDH (primary treatment or recurrence after conventional surgery) at 15 centers were included. Clinical details and follow-up were collected prospectively. Primary clinical and radiographic outcomes were the proportion of patients requiring additional surgical treatment within 90 d after index treatment and proportion with > 50% cSDH thickness reduction on follow-up computed tomography imaging within 90 d. National Institute of Health Stroke Scale and modified Rankin Scale were also clinical outcomes. RESULTS: A total of 138 patients were included (mean age: 69.8, 29% female). A total of 15 patients underwent bilateral interventions for 154 total embolizations (66.7% primary treatment). At presentation, 30.4% and 23.9% of patients were on antiplatelet and anticoagulation therapy, respectively. Median admission cSDH thickness was 14 mm. A total of 46.1% of embolizations were performed under general anesthesia, and 97.4% of procedures were successfully completed. A total of 70.2% of embolizations used particles, and 25.3% used liquid embolics with no significant outcome difference between embolization materials (P >. 05). On last follow-up (mean 94.9 d), median cSDH thickness was 4 mm (71% median thickness reduction). A total of 70.8% of patients had >50% improvement on imaging (31.9% improved clinically), and 9 patients (6.5%) required further cSDH treatment. There were 16 complications with 9 (6.5%) because of continued hematoma expansion. Mortality rate was 4.4%, mostly unrelated to the index procedure but because of underlying comorbidities. CONCLUSION: MMA embolization may provide a safe and efficacious minimally invasive alternative to conventional surgical techniques.

AB - BACKGROUND: Middle meningeal artery (MMA) embolization has emerged as a promising treatment for chronic subdural hematoma (cSDH). OBJECTIVE: To determine the safety and efficacy of MMA embolization. METHODS: Consecutive patients who underwent MMA embolization for cSDH (primary treatment or recurrence after conventional surgery) at 15 centers were included. Clinical details and follow-up were collected prospectively. Primary clinical and radiographic outcomes were the proportion of patients requiring additional surgical treatment within 90 d after index treatment and proportion with > 50% cSDH thickness reduction on follow-up computed tomography imaging within 90 d. National Institute of Health Stroke Scale and modified Rankin Scale were also clinical outcomes. RESULTS: A total of 138 patients were included (mean age: 69.8, 29% female). A total of 15 patients underwent bilateral interventions for 154 total embolizations (66.7% primary treatment). At presentation, 30.4% and 23.9% of patients were on antiplatelet and anticoagulation therapy, respectively. Median admission cSDH thickness was 14 mm. A total of 46.1% of embolizations were performed under general anesthesia, and 97.4% of procedures were successfully completed. A total of 70.2% of embolizations used particles, and 25.3% used liquid embolics with no significant outcome difference between embolization materials (P >. 05). On last follow-up (mean 94.9 d), median cSDH thickness was 4 mm (71% median thickness reduction). A total of 70.8% of patients had >50% improvement on imaging (31.9% improved clinically), and 9 patients (6.5%) required further cSDH treatment. There were 16 complications with 9 (6.5%) because of continued hematoma expansion. Mortality rate was 4.4%, mostly unrelated to the index procedure but because of underlying comorbidities. CONCLUSION: MMA embolization may provide a safe and efficacious minimally invasive alternative to conventional surgical techniques.

KW - Chronic subdural hematoma

KW - Chronic subdural hemorrhage

KW - Middle meningeal artery embolization

KW - Refractory subdural hematoma

KW - Refractory subdural hemorrhage

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DO - 10.1093/neuros/nyaa379

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AN - SCOPUS:85100070477

SN - 0148-396X

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JO - Neurosurgery

JF - Neurosurgery

IS - 2

ER -

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations

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Keywords

ASJC Scopus subject areas

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