The "Bright Falx" Sign-Midline Embolic Penetration Is Associated With Faster Resolution of Chronic Subdural Hematoma After Middle Meningeal Artery Embolization: A Case Series.

Autor:	Samarage HM; Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA., Kim WJ; Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA., Zarrin D; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA., Goel K; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA., Chin-Hsiu Wang A; Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA., Johnson J; Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA., Kaneko N; Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA., Nour M; Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA., Szeder V; Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA., Tateshima S; Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA., Jahan R; Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA., Duckwiler G; Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA., Colby GP; Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA.; Department of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, California, USA.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2022 Sep 01; Vol. 91 (3), pp. 389-398. Date of Electronic Publication: 2022 May 17.
DOI:	10.1227/neu.0000000000002038
Abstrakt:	Background: Chronic subdural hematomas (CSDHs) are common in the elderly population and patients taking antiplatelet/anticoagulation medications. Middle meningeal artery (MMA) embolization has become an adjunctive treatment to observation and surgery. Despite many embolization techniques, best practices for optimal CSDH resolution remain unknown. Objective: To report a retrospective case series of MMA embolization for CSDHs regarding rate of hematoma improvement and the significance of distal embolic penetration into the falx. Methods: Retrospective chart review was performed on all patients who underwent MMA embolization for CSDHs between January 2017 and June 2021. Patient demographics, clinical presentation, anticoagulant use, and radiographic features were collected. Pre-embolization and postembolization computed tomography scans were analyzed for volumetric changes and assessed for midline penetration of embolic material in the falx. Results: MMA embolization was performed in 37 patients and 53 hemispheres. Older patients took longer to obtain complete resolution of CSDHs (r = 0.47, P = .03). Patients with larger pre-embolization (r = 0.57, P = .007) and postembolization (r = 0.56, P = .008) CSDH volumes took longer to completely resolve. Patients who had n-butyl cyanoacrylate embolization with midline penetration, as evidenced by the "bright falx" sign, had faster improvement rates than those who did not (5.64 cm 3 /d vs 1.2 cm 3 /d, P = .02). Conclusion: Distal penetration of embolic material, particularly n-butyl cyanoacrylate, into the falx may lead to more rapid improvement of CSDH. (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)
Databáze:	MEDLINE
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