Language
English
Publication Date
6-1-2025
Journal
Interventional Neuroradiology
DOI
10.1177/15910199231162665
PMID
36908233
PMCID
PMC12202886
PubMedCentral® Posted Date
3-13-2023
PubMedCentral® Full Text Version
Post-print
Abstract
Background
By 2030, nonacute subdural hematomas (NASHs) will likely be the most common cranial neurosurgery pathology. Treatment with surgical evacuation may be necessary, but the recurrence rate after surgery is as high as 30%. Minimally invasive middle meningeal artery embolization (MMAE) during the perioperative period has been posited as an adjunctive treatment to decrease the potential for recurrence after surgical evacuation. We evaluated the safety and efficacy of concurrent MMAE in a multi-institutional cohort.
Methods
Data from 145 patients (median age 73 years) with NASH who underwent surgical evacuation and MMAE in the perioperative period were retrospectively collected from 15 institutions. The primary outcome was the rate of recurrence requiring repeat surgical intervention. We collected clinical, treatment, and radiographic data at initial presentation, after evacuation, and at 90-day follow-up. Outcomes data were also collected.
Results
Preoperatively, the median hematoma width was 18 mm, and subdural membranes were present on imaging in 87.3% of patients. At 90-day follow-up, median NASH width was 6 mm, and 51.4% of patients had at least a 50% decrease of NASH size on imaging. Eight percent of treated NASHs had recurrence that required additional surgical intervention. Of patients with a modified Rankin Scale score at last follow-up, 87.2% had the same or improved mRS score. The total all-cause mortality was 6.0%.
Conclusion
This study provides evidence from a multi-institutional cohort that performing MMAE in the perioperative period as an adjunct to surgical evacuation is a safe and effective means to reduce recurrence in patients with NASHs.
Keywords
Humans, Female, Male, Aged, Embolization, Therapeutic, Retrospective Studies, Treatment Outcome, Middle Aged, Meningeal Arteries, Aged, 80 and over, Hematoma, Subdural, Recurrence, Nonacute subdural hematoma, middle meningeal artery embolization, adjunct, recurrence, outcomes
Published Open-Access
yes
Recommended Citation
Salah, Walid K; Baker, Cordell; Scoville, Jonathan P; et al., "Middle Meningeal Artery Embolization as a Perioperative Adjunct to Surgical Evacuation of Nonacute Subdural Hematomas: An Multicenter Analysis of Safety and Efficacy" (2025). Faculty and Staff Publications. 5338.
https://digitalcommons.library.tmc.edu/baylor_docs/5338