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Middle Meningeal Artery Embolization for Membranous Versus Nonmembranous Subdural Hematomas: A Retrospective and
Joshua H Weinberg1, Asad Akhter1, Amanda Zakeri1
1Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Background:
Middle meningeal artery (MMA) embolization is a treatment option for chronic subdural hematomas (SDHs). The theorized mechanism of MMA embolization is devascularization of membranes that contribute to recurrence. In the present study, we aimed to determine whether MMA embolization is more efficacious for SDHs with radiographically visible membranes.
Methods:
A multicenter, retrospective cohort study was performed of patients with SDHs who underwent MMA embolization alone or with burr hole drainage. The SDHs were categorized as membranous or nonmembranous according to the radiographic appearance. The patient characteristics and outcomes were compared between the 2 groups.
Results:
A total of 99 patients with 117 MMA embolization procedures were included. Of the 99 patients, 73.7% with a membranous SDH and 61.0% with a nonmembranous SDH underwent MMA embolization alone. The remaining patients underwent MMA embolization in conjunction with burr hole evacuation. The overall recurrence rate was 10.7%. No significant differences were found in complications (P = 0.417), recurrence (P = 0.898), or retreatment (P = 0.999) among the membranous and nonmembranous groups.
Conclusions:
To the best of our knowledge, this is the first multicenter study evaluating the effect of membrane presence in SDHs undergoing embolization. Membrane presence in patients undergoing MMA embolization did not correlate with recurrence or retreatment, suggesting that membrane presence should not be used as the sole selection criterion for MMA embolization. Although prospective studies of larger cohorts are needed, the results from the present study provide information on the potential implications of membranes in determining the optimal treatment paradigm for SDHs.
Insights
Middle meningeal artery (MMA) embolization is a treatment for chronic subdural hematomas (SDHs). This study found that the presence of membranes in SDHs did not affect recurrence or retreatment rates after MMA embolization.
Area of Science:
- Neurosurgery
- Interventional Radiology
Background:
- Middle meningeal artery (MMA) embolization is a treatment for chronic subdural hematomas (SDHs).
- The mechanism is thought to involve devascularization of recurrent membranes.
- This study investigated if MMA embolization efficacy differs based on visible membranes.
Purpose of the Study:
- To determine if MMA embolization is more effective for SDHs with visible membranes.
- To compare outcomes in patients with membranous versus nonmembranous SDHs.
Main Methods:
- Multicenter, retrospective cohort study.
- Patients with SDHs undergoing MMA embolization (alone or with drainage) were analyzed.
- SDHs were classified as membranous or nonmembranous based on imaging.
Main Results:
- 99 patients (117 procedures) were included.
- Recurrence rate was 10.7% overall.
- No significant differences in complications, recurrence, or retreatment were found between membranous and nonmembranous SDH groups.
Conclusions:
- Membrane presence in SDHs undergoing MMA embolization did not correlate with recurrence or retreatment.
- Membrane presence alone should not dictate MMA embolization candidacy.
- Further prospective studies are needed to refine SDH treatment paradigms.
