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Advances in chronic subdural hematoma and membrane imaging
Huanwen Chen1,2, Marco Colasurdo3, Ajay Malhotra4
1National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
Insights
Chronic subdural hematoma (cSDH) is a growing neurosurgical concern with high recurrence rates. Advanced imaging like MR and dual-energy CT may help predict recurrence and guide treatment, including middle meningeal artery embolization (MMAE).
Area of Science:
- Neurosurgery and Radiology
- Cranial neurosurgical diseases
- Advanced medical imaging
Background:
- Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition with significant recurrence rates despite current treatments.
- Middle meningeal artery embolization (MMAE) is an emerging therapy for cSDH, but factors influencing recurrence are not fully understood.
- Developing new radiographic biomarkers for hematoma and membrane assessment is crucial for improving patient outcomes.
Purpose of the Study:
- To review current imaging techniques for subdural hematomas and membranes.
- To explore the potential of MR and dual-energy CT in predicting cSDH recurrence.
- To assess the role of advanced imaging in surgical planning and patient selection for MMAE.
Main Methods:
- Narrative review of existing literature on cSDH imaging.
- Analysis of current state-of-the-art imaging modalities for subdural hematomas and membranes.
- Discussion of the application of MR and dual-energy CT in clinical practice.
Main Results:
- Current imaging methods provide insights into cSDH characteristics.
- Novel radiographic biomarkers are under active investigation to improve assessment.
- Advanced imaging techniques show promise in predicting treatment response and recurrence.
Conclusions:
- Accurate imaging is essential for managing chronic subdural hematoma.
- MR and dual-energy CT imaging hold potential for predicting cSDH recurrence and guiding treatment decisions.
- Further research into radiographic biomarkers can optimize patient selection for therapies like MMAE.
Abstract:
Chronic subdural hematoma (cSDH) is projected to become the most common cranial neurosurgical disease by 2030. Despite medical and surgical management, recurrence rates remain high. Recently, middle meningeal artery embolization (MMAE) has emerged as a promising treatment; however, determinants of disease recurrence are not well understood, and developing novel radiographic biomarkers to assess hematomas and cSDH membranes remains an active area of research. In this narrative review, we summarize the current state-of-the-art for subdural hematoma and membrane imaging and discuss the potential role of MR and dual-energy CT imaging in predicting cSDH recurrence, surgical planning, and selecting patients for embolization treatment.
