Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With a D5W Push Technique: A Multicentric North American Study of 269 Patients.

Autor:	Abdelsalam A; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Ramsay IA; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Luther EM; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Burks JD; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Wu EM; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Silva MA; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Thompson JW; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Bandes M; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Fountain HB; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Eatz T; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Sanikommu S; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Abla AA; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA., Salem MM; Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA., Burkhardt JK; Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA., Srinivasan VM; Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA., Brunozzi D; Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA., Alaraj A; Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA., Atwal G; Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA., Al-Mufti F; Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, New York, USA., Kellner CP; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Rai AT; Department of Neuroradiology, Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA., Starke RM; Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
Jazyk:	angličtina
Zdroj:	Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2024 Sep 23. Date of Electronic Publication: 2024 Sep 23.
DOI:	10.1227/ons.0000000000001369
Abstrakt:	Background and Objectives: As the aging population increases, the incidence of chronic subdural hematomas (cSDHs) is expected to rise. Surgical evacuation, though effective, sees up to 30% recurrence. Middle meningeal artery (MMA) embolization, particularly with n-butyl cyanoacrylate (n-BCA) glue diluted in D5W for distal penetration, has shown promise in reducing recurrences. Limited reports have investigated the safety and technical feasibility of n-BCA as a primary liquid embolic agent using the D5W push technique in cSDH. This series is the largest in the literature investigating the outcomes of this technique in cSDH. Methods: A multicenter retrospective database analysis was conducted on consecutive patients who underwent MMA embolization using n-BCA embolisate. Data collected included patient demographics, procedural information, angiographic data, and periprocedural complications. Results: The study included 269 patients with a median age of 76 years. Nearly half of the patients had previous surgeries, and 93 underwent contralateral embolization for bilateral cSDH. Successful MMA embolization with effective distal penetration was achieved in all cases. The complication rate was 2.2%. Significant improvements were noted at a 60-day follow-up, with a median reduction in cSDH diameter of 40.6% (P < .001) and 53% of patients showing neurological improvement. No recurrent cSDH or need for retreatment was observed in patients who underwent follow-up. Conclusion: MMA embolization using n-BCA with the D5W push technique is safe and technically feasible. It can be used adjunctively or as an alternative to surgery in patients with cSDH, resulting in decreased recurrence, high technical success, improved distal penetration, and low complication rates. (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
Databáze:	MEDLINE
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