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Published on: August 11, 2015
Middle meningeal artery embolization reduces recurrence following surgery for septated chronic subdural hematomas
Juan Carlos Martinez-Gutierrez1, Bryden H Dawes1, Hussein A Zeineddine1
1Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Insights
Middle meningeal artery embolization (MMAE) significantly reduces reoperation and recurrence rates for septated chronic subdural hematomas (cSDH) when used alongside surgical evacuation. This adjuvant therapy shows high effectiveness in preventing cSDH recurrence.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Surgery
Background:
- Septated chronic subdural hematomas (cSDH) frequently recur after surgical evacuation.
- Middle meningeal artery embolization (MMAE) is a potential adjuvant therapy for preventing cSDH recurrence.
- The efficacy of MMAE as an adjunct to surgery for cSDH requires further definition.
Purpose of the Study:
- To evaluate the effectiveness of MMAE as an adjuvant therapy for secondary prevention in patients with septated cSDH.
- To compare reoperation and recurrence rates between patients treated with surgery alone versus surgery plus MMAE.
Main Methods:
- Retrospective review of septated cSDH cases treated at an institution.
- Comparison of a surgery-only group (pre-2018) with a surgery plus MMAE group (post-2018).
- Primary outcome: reoperation rate. Secondary outcomes: recurrence, hematoma thickness, midline shift.
Main Results:
- 34 cSDHs in 28 patients (surgery+MMAE) and 95 cSDHs in 83 patients (surgery-only) were analyzed.
- No significant baseline differences were observed between the groups.
- The surgery-only group had a significantly higher reoperation rate (16.8%) compared to the surgery+MMAE group (0.0%) (p=0.006).
- The surgery+MMAE group showed a significantly reduced incidence of recurrence (p=0.011).
Conclusions:
- MMAE is highly effective in preventing recurrence and reoperation for septated cSDH.
- MMAE serves as a beneficial adjunct to surgical evacuation for this patient population.
- This approach offers a promising strategy for improving outcomes in septated cSDH management.
Background:
Septated chronic subdural hematomas (cSDH) have high rates of recurrence despite surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as a promising adjuvant for secondary prevention, yet its efficacy remains ill-defined.
Methods:
This is a retrospective review of septated cSDH cases treated at our institution. The surgery-only group was derived from cases performed before 2018, and the surgery+MMAE group was derived from cases performed 2018 or later. The primary outcome was reoperation rate. Secondary outcomes were recurrence, change in hematoma thickness, and midline shift.
Results:
A total of 34 cSDHs in 28 patients (surgery+MMAE) and 95 cSDHs in 83 patients (surgery-only) met the inclusion criteria. No significant difference in baseline characteristics between groups was identified. The reoperation rate was significantly higher in the surgery-only group (n = 16, 16.8%) compared with the surgery+MMAE cohort (n = 0, 0.0%) (p=0.006). A reduced incidence of recurrence (p=0.011) was also seen in the surgery+MMAE group.
Conclusions:
MMAE for septated cSDH was found to be highly effective in preventing recurrence and reoperation. MMAE is an adjunct to surgical evacuation may be of particular benefit in this patient cohort.
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