Akademik Veri Yönetim Sistemi
2024 TGRD 19. Yıllık Toplantısı, Antalya, Türkiye, 2 - 06 Şubat 2024, ss.10-15
Introduction:
Chronic subdural hematoma (CSDH) is one of the most encountered neurosurgical cases and is defined as a collection of blood degradation products in the subdural space. With the population aging in the world and the increased use of antiplatelet and anticoagulation drugs, CSDH is expected to be the most frequent reason for emergency neurosurgery by 2030.
CSDH may cause effacement of brain structures leading to stroke-like symptoms or dementia.Surgery is effective in relieving the mass effect of hematoma but does not change the underlying pathophysiologic mechanisms, and recurrence occurs frequently.
MMA embolization is a new treatment method for CSDH.
In this study, the effect of middle meningeal artery (MMA) embolization using polyvinyl alcohol particles on chronic subdural hematoma (CSDH) is evaluated.
Materials and methods:
The study included 13 patients (6 women, 7 men) who were embolized for CSDH at our institution between 2019 and 2023 years. PVA 355-500 u nonspherical particle was used in all cases.
The success of the procedure was evaluated by comparing brain CT scans taken before MMA embolization with control CT scans taken 6 months post-embolization.
Before the procedure, all patients underwent CT angiography of the head and neck to examine the anatomy of the arch and any variations and a femoral or radial approach was selected accordingly.
Embolization was performed via a radial approach in patients with severe aortic arch tortuosity or type 3 arch.
Embolization was performed by investigating the presence of foramen spinosum, the origin of the ophthalmic artery, and the presence of dangerous collaterals extending between the orbit and MMA artery with head-neck CT angiography and Digital Subtraction Angiography (DSA).
Clinical and radiologic follow-up examinations with CT scans were performed at 1, 3, and 6 months after embolization.
The maximal thickness of CSDH was measured at the level of maximum axial thickness, and midline shift was measured on the axial slices on CT images
Results:
The patients ranged in age between 57 and 88 years, with a mean age of 69.5.
Unilateral CSDH was detected in 9 cases, while bilateral CSDH was detected in 4 cases.
The largest hematoma thickness was 30mm and the smallest hematoma thickness was 6.5mm.
MMA embolization was used as the primary treatment method in seven cases, while it was used to treat post-surgical recurrence and residual hematoma in six cases.
Embolization was successfully performed in all cases. No complications were observed in the early or late period.
The femoral approach was used in 9 patients and the radial approach was used in 4 patients.
In the 6th-month follow-up CT, subdural hematomas were observed to have completely regressed in 12 cases, in one case, a subdural hematoma was observed to have substantially regressed.
Conclusion
MMA embolization is seen as an effective method in the treatment of chronic subdural hematoma.
References :
1.McDonough R, Bechstein M, Fiehler J, Zanolini U, Rai H, Siddiqui A, Shotar E, Rouchaud A, Kallmes K, Goyal M, Gellissen S. Radiologic Evaluation Criteria for Chronic Subdural Hematomas: Recommendations for Clinical Trials. AJNR Am J Neuroradiol. 2022 ;43(11):1550-1558.
2.Ban SP, Hwang G, Byoun HS, Kim T, Lee SU, Bang JS, Han JH, Kim CY, Kwon OK, Oh CW. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma. Radiology. 2018;286 (3):992-999.
3.Atefi N, Alcock S, Silvaggio JA, Shankar J. Clinical Outcome and Recurrence Risk of Chronic Subdural Hematoma After Surgical Drainage. Cureus. 2023 Feb 27;15(2):e35525.
Keywords : chronic subdural hematoma, recurrence, subdural space