Middle meningeal artery embolization following surgical evacuation of symptomatic chronic subdural hematoma improves outcomes, interim results of a prospective randomized trial.

Autor: Debs LH; Neurosurgery Department, Medical College of Georgia, Augusta, GA, USA. Electronic address: ldebs@augusta.edu., Vale FL; Neurosurgery Department, Medical College of Georgia, Augusta, GA, USA., Walker S; Neurosurgery Department, Medical College of Georgia, Augusta, GA, USA., Toro D; Neurosurgery Department, Medical College of Georgia, Augusta, GA, USA., Mansouri S; Neurosurgery Department, Medical College of Georgia, Augusta, GA, USA., Macomson SD; Neurosurgery Department, Medical College of Georgia, Augusta, GA, USA., Rahimi SY; Neurosurgery Department, Medical College of Georgia, Augusta, GA, USA.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2024 Oct; Vol. 128, pp. 110783. Date of Electronic Publication: 2024 Aug 13.
DOI: 10.1016/j.jocn.2024.110783
Abstrakt: Background: Outcomes after surgical treatment of chronic subdural hematoma (cSDH) remain undesirable in a significant proportion of patients. We aimed to show the role of middle meningeal artery (MMA) embolization and to demonstrate its benefits.
Methods: Thirty-five patients with symptomatic cSDH were enrolled in a prospective randomized trial following evacuation surgery. Participants were randomized to embolization or control group (expectant management following surgical evacuation without embolization). Patients were followed throughout their hospitalization and outpatient follow-ups. The main goals of this planned interim analysis were to assess neurological outcome and resource utilization.
Results: The groups were comparable in terms of sex, age and follow-up retention rates. Side(s) of intervention(s) and hematoma size were similar. There was no statistical difference in neurological examination improvement at discharge, but at follow-up, we observed a decline in neurologic exam in the control group (p = 0.03). Control group participants required more re-interventions (p = 0.02) and were followed in clinic and during related readmissions for longer (p = 0.02). The number of imaging studies obtained in relation to the disease management was higher in the control group (p = 0.01).
Conclusions: Our results suggest a beneficial role for the addition of MMA embolization to surgical intervention in the treatment of symptomatic chronic subdural hematoma. Neurological outcomes were significantly better in the embolization group. This contributed to less need for follow-up, re-interventions, and imaging studies.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
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