Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting?
Background: Endovascular treatment of patients with chronic subdural hematoma using middle meningeal artery (MMA) embolization could become an alternative to surgical hematoma evacuation. The aim of the study was to compare methods and identify parameters to help determine the correct treatment moda...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-12-01
|
| Series: | Neurology International |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2035-8377/15/4/96 |
| _version_ | 1797379754691657728 |
|---|---|
| author | Dalibor Sila Francisco Luis Casnati Mária Vojtková Philipp Kirsch Stefan Rath František Charvát |
| author_facet | Dalibor Sila Francisco Luis Casnati Mária Vojtková Philipp Kirsch Stefan Rath František Charvát |
| author_sort | Dalibor Sila |
| collection | DOAJ |
| description | Background: Endovascular treatment of patients with chronic subdural hematoma using middle meningeal artery (MMA) embolization could become an alternative to surgical hematoma evacuation. The aim of the study was to compare methods and identify parameters to help determine the correct treatment modality. Methods: We retrospectively reviewed 142 cases conducted internally; 78 were treated surgically and 64 were treated using MMA embolization. We analyzed the treatment failure rate and complications, and using a binary logistic regression model, we identified treatment failure risk factors. Results: We found a comparable treatment failure rate of 23.1% for the surgery group and 21.9% for the MMA embolization group. However, in the MMA embolization group, 11 cases showed treatment failure due to early neurological worsening with a need for concomitant surgery. We also found a recurrence of hematoma in 15.4% of cases in the surgery group and 6.3% of cases in the MMA embolization group. Conclusion: Both modalities have their advantages; however, correct identification is crucial for treatment success. According to our findings, hematomas with a maximal width of <18 mm, a midline shift of <5 mm, and no acute or subacute (hyperdense) hematoma could be treated with MMA embolization. Hematomas with a maximal width of >18 mm, a midline shift of >5 mm, and no membranous segmentation could have better outcomes after surgical treatment. |
| first_indexed | 2024-03-08T20:28:35Z |
| format | Article |
| id | doaj.art-00c07effee5d49c5aec2e0b89171b27a |
| institution | Directory Open Access Journal |
| issn | 2035-8377 |
| language | English |
| last_indexed | 2024-03-08T20:28:35Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Neurology International |
| spelling | doaj.art-00c07effee5d49c5aec2e0b89171b27a2023-12-22T14:29:35ZengMDPI AGNeurology International2035-83772023-12-011541480148810.3390/neurolint15040096Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting?Dalibor Sila0Francisco Luis Casnati1Mária Vojtková2Philipp Kirsch3Stefan Rath4František Charvát5Department of Neurosurgery and Interventional Neuroradiology, Donau Isar Klinikum Deggendorf, Perlasberger Str. 41, 94469 Deggendorf, GermanyDepartment of Neurosurgery and Interventional Neuroradiology, Donau Isar Klinikum Deggendorf, Perlasberger Str. 41, 94469 Deggendorf, GermanyDepartment of Statistics, Faculty of Economic Informatics, University of Economics in Bratislava, Dolnozemská Cesta 1/b, Bratislava 85235, SlovakiaDepartment of Radiology and Interventional Radiology, Donau Isar Klinikum Deggendorf, Perlasberger Str. 41, 94469 Deggendorf, GermanyDepartment of Neurosurgery and Interventional Neuroradiology, Donau Isar Klinikum Deggendorf, Perlasberger Str. 41, 94469 Deggendorf, GermanyDepartment of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague, Military University Hospital, U Vojenské Nemocnice 1200, 16902 Praha, Czech RepublicBackground: Endovascular treatment of patients with chronic subdural hematoma using middle meningeal artery (MMA) embolization could become an alternative to surgical hematoma evacuation. The aim of the study was to compare methods and identify parameters to help determine the correct treatment modality. Methods: We retrospectively reviewed 142 cases conducted internally; 78 were treated surgically and 64 were treated using MMA embolization. We analyzed the treatment failure rate and complications, and using a binary logistic regression model, we identified treatment failure risk factors. Results: We found a comparable treatment failure rate of 23.1% for the surgery group and 21.9% for the MMA embolization group. However, in the MMA embolization group, 11 cases showed treatment failure due to early neurological worsening with a need for concomitant surgery. We also found a recurrence of hematoma in 15.4% of cases in the surgery group and 6.3% of cases in the MMA embolization group. Conclusion: Both modalities have their advantages; however, correct identification is crucial for treatment success. According to our findings, hematomas with a maximal width of <18 mm, a midline shift of <5 mm, and no acute or subacute (hyperdense) hematoma could be treated with MMA embolization. Hematomas with a maximal width of >18 mm, a midline shift of >5 mm, and no membranous segmentation could have better outcomes after surgical treatment.https://www.mdpi.com/2035-8377/15/4/96middle meningeal arterysubdural hematomaembolizationendovascular treatmentsurgeryburr hole trepanation |
| spellingShingle | Dalibor Sila Francisco Luis Casnati Mária Vojtková Philipp Kirsch Stefan Rath František Charvát Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting? Neurology International middle meningeal artery subdural hematoma embolization endovascular treatment surgery burr hole trepanation |
| title | Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting? |
| title_full | Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting? |
| title_fullStr | Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting? |
| title_full_unstemmed | Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting? |
| title_short | Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting? |
| title_sort | middle meningeal artery embolization versus surgery in patients with chronic subdural hematoma no more fence sitting |
| topic | middle meningeal artery subdural hematoma embolization endovascular treatment surgery burr hole trepanation |
| url | https://www.mdpi.com/2035-8377/15/4/96 |
| work_keys_str_mv | AT daliborsila middlemeningealarteryembolizationversussurgeryinpatientswithchronicsubduralhematomanomorefencesitting AT franciscoluiscasnati middlemeningealarteryembolizationversussurgeryinpatientswithchronicsubduralhematomanomorefencesitting AT mariavojtkova middlemeningealarteryembolizationversussurgeryinpatientswithchronicsubduralhematomanomorefencesitting AT philippkirsch middlemeningealarteryembolizationversussurgeryinpatientswithchronicsubduralhematomanomorefencesitting AT stefanrath middlemeningealarteryembolizationversussurgeryinpatientswithchronicsubduralhematomanomorefencesitting AT frantisekcharvat middlemeningealarteryembolizationversussurgeryinpatientswithchronicsubduralhematomanomorefencesitting |