Middle Meningeal Artery Embolization versus Surgery in Patients with Chronic Subdural Hematoma—No More Fence Sitting?

Author:

Sila Dalibor12,Casnati Francisco Luis1,Vojtková Mária3ORCID,Kirsch Philipp4,Rath Stefan1,Charvát František2

Affiliation:

1. Department of Neurosurgery and Interventional Neuroradiology, Donau Isar Klinikum Deggendorf, Perlasberger Str. 41, 94469 Deggendorf, Germany

2. Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague, Military University Hospital, U Vojenské Nemocnice 1200, 16902 Praha, Czech Republic

3. Department of Statistics, Faculty of Economic Informatics, University of Economics in Bratislava, Dolnozemská Cesta 1/b, Bratislava 85235, Slovakia

4. Department of Radiology and Interventional Radiology, Donau Isar Klinikum Deggendorf, Perlasberger Str. 41, 94469 Deggendorf, Germany

Abstract

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.

Publisher

MDPI AG

Subject

Neurology (clinical)

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