Middle meningeal artery embolization as a perioperative adjunct to surgical evacuation of nonacute subdural hematomas: An multicenter analysis of safety and efficacy.

Autor:	Salah WK; Department of Neurosurgery, Clinical Neurosciences Center, 7060University of Utah, Salt Lake City, Utah, USA.; School of Medicine, 7060University of Utah, Salt Lake City, Utah, USA., Baker C; Department of Neurosurgery, Clinical Neurosciences Center, 7060University of Utah, Salt Lake City, Utah, USA., Scoville JP; Department of Neurosurgery, Clinical Neurosciences Center, 7060University of Utah, Salt Lake City, Utah, USA., Hunsaker JC; School of Medicine, 7060University of Utah, Salt Lake City, Utah, USA., Ogilvy CS; Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA., Moore JM; Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA., Riina HA; Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA., Levy EI; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, 14221, USA., Spiotta AM; Department of Neurosurgery, 2345Medical University of South Carolina, Charleston, South Carolina, USA., Jankowitz BT; Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Michael Cawley C 3rd; Department of Neurosurgery, Emory University, Atlanta, Georgia, USA., Khalessi AA; Department of Neurosurgery, University of California-San Diego, La Jolla, California, USA., Tanweer O; Department of Neurosurgery, 3989Baylor College of Medicine, Houston, Texas, USA., Hanel R; Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA., Gross BA; Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Kuybu O; Department of Neurology, 6614University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Hoang AN; Department of Neurosurgery, 205297Houston Methodist Neurological Institute, Houston, Texas, USA., Baig AA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, 14221, USA., Khorasanizadeh MH; Department of Neurosurgery, 5944Mount Sinai Health System, New York, New York, USA., Mendez AA; Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Cortez G; Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA., Davies JM; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, 14221, USA., Narayanan S; Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Howard BM; Department of Neurosurgery, Emory University, Atlanta, Georgia, USA., Lang MJ; Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Siddiqui AH; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, 14221, USA., Thomas A; Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.; Department of Neurosurgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey, USA., Kan P; Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA., Burkhardt JK; Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Salem MM; Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA., Grandhi R; Department of Neurosurgery, Clinical Neurosciences Center, 7060University of Utah, Salt Lake City, Utah, USA.
Jazyk:	angličtina
Zdroj:	Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences [Interv Neuroradiol] 2023 Mar 13, pp. 15910199231162665. Date of Electronic Publication: 2023 Mar 13.
DOI:	10.1177/15910199231162665
Abstrakt:	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.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu