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Published on: October 2, 2014
Preclinical feasibility study for transvascular drainage of non-acute subdural hematomas
Yang Liu1,2, Sarosh Irfan Madhani2,3, Jorge Luis Arturo Larco2,4
1Global Institute of Future Technology, Shanghai Jiao Tong University, Shanghai, China.
Insights
This study suggests a single endovascular procedure may effectively treat chronic subdural hematoma (cSDH) by draining it through the middle meningeal artery (MMA). This approach could simplify treatment and reduce patient risk compared to current two-step methods.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Biomedical Engineering
Background:
- Chronic subdural hematoma (cSDH) treatment typically involves surgical evacuation and middle meningeal artery embolization (MMAe).
- This standard two-step approach presents challenges including increased procedural complexity, hospitalization, and patient risk.
- A single-session endovascular strategy is explored to streamline cSDH management.
Purpose of the Study:
- To evaluate the feasibility of a single-session endovascular procedure for managing chronic subdural hematoma (cSDH).
- To assess anatomical, rheological, and biomechanical factors supporting endovascular drainage via the middle meningeal artery (MMA).
Main Methods:
- 3D heat mapping of cSDH distribution from CT scans (n=69).
- Analysis of middle meningeal artery (MMA) and superior sagittal sinus (SSS) anatomy and perforation trajectories (n=107).
- Rheological assessment of subdural hematoma (SDH) samples (n=41) and microcatheter aspiration feasibility testing (n=16).
- Quantification of dura perforation forces (n=10).
Main Results:
- cSDH was localized to parietal convexities under MMA branches, with minimal midline involvement.
- The MMA's posterior division (1.23±0.23 mm diameter) accommodated microcatheters in over 90% of cases.
- SDH samples demonstrated shear-thinning viscosity, with mean aspiration time of 1.21±0.54 min/10 mL.
- Dura perforation forces averaged 0.68±0.24 N (normal) and 1.29±0.48 N (calcified).
Conclusions:
- Anatomical, rheological, and biomechanical data support the feasibility of endovascular drainage of cSDH through the MMA.
- A single-session endovascular approach for cSDH management is a promising alternative to current multi-step treatments.
Background:
Non-acute or chronic subdural hematoma (cSDH) is commonly treated with surgical evacuation followed by middle meningeal artery embolization (MMAe). This two step approach increases procedural complexity and redundancy, hospitalization duration, and patient risk. We hypothesized that cSDH could be managed through a single session endovascular procedure and conducted a multimodal preclinical study to evaluate feasibility.
Methods:
We performed three-dimensional heat mapping of hematoma distribution from preoperative CT scans (n=69) and analyzed middle meningeal artery (MMA) and superior sagittal sinus (SSS) anatomy and perforation trajectories using imaging from 107 patients. Rheological properties of 41 SDH samples were assessed using hybrid rheometry and modeled with the Carreau equation. Aspiration feasibility was tested using a 0.027 inch microcatheter (n=16), and dura perforation forces were quantified with a 28 G needle in fresh cadaveric dura (n=10).
Results:
Heat mapping localized cSDH to the parietal convexities (>80% probability) under the branches of the MMA, with limited midline involvement and proximity to the SSS (<10%). The posterior division of the MMA (diameter 1.23±0.23 mm) accommodated a 0.027 inch microcatheter in >90% of cases, with perforation trajectories targeting high probability hematoma zones in 105 of 107 cases. SDH samples exhibited shear thinning viscosity (η ₀=172 mPa×s, η ∞=2.78 mPa×s), with mean aspiration times of 1.21±0.54 min per 10 mL. Perforation forces averaged 0.68±0.24 N in normal and 1.29±0.48 N in calcified dura (P=0.05).
Conclusion:
Anatomical, rheological, and biomechanical data from this study support the feasibility of endovascular drainage of cSDH through the MMA.
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