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Is Embolization a Safe Treatment Option for Certain Traumatic Subdural Hematomas?

Cody Neuburger1, Siman Antar1, Mohamad Halloum1

  • 1Department of Surgery, The University of Kansas School of Medicine-Wichita, Wichita, Kansas (Neuburger, Antar, Reyes, Haan); Department of Trauma Services, Ascension Via Christi Hospitals, Wichita (Haan).

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Middle meningeal artery (MMA) embolization shows promise as a safe adjunctive treatment for acute subdural hematoma (SDH). This study suggests MMA embolization may be effective, especially in less severe acute SDH cases.

Keywords:
acute subdural hematomabrain hemorrhageembolizationtherapeutictraumatic

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Area of Science:

  • Neurosurgery
  • Interventional Radiology
  • Trauma Care

Background:

  • Middle meningeal artery (MMA) embolization is established for chronic subdural hematoma (SDH).
  • The safety and efficacy of MMA embolization in acute SDH are not well-defined.
  • This study investigates MMA embolization for acute SDH management.

Purpose of the Study:

  • To evaluate the safety of MMA embolization in patients with acute subdural hematoma.
  • To compare outcomes between patients with acute SDH who underwent MMA embolization and those who did not.

Main Methods:

  • Retrospective review of 33 adult acute SDH patients treated between July 2021 and July 2023.
  • Comparison of demographics, injury characteristics, treatments, and outcomes between embolized (n=17) and non-embolized (n=16) groups.
  • Analysis included patients with acute bleeding and acute-on-chronic bleeding.

Main Results:

  • The MMA embolization group was older (median 71.0 vs. 37.5 years) and had higher median Glasgow Coma Scale (GCS) scores (14.0 vs. 11.5).
  • No patients required craniotomy after MMA embolization.
  • One patient managed non-operatively after embolization underwent burr hole evacuation and was discharged.

Conclusions:

  • MMA embolization appears safe and potentially effective as an adjunct for acute SDH management.
  • The procedure may be particularly beneficial in less severe acute SDH cases.
  • Further large-scale, controlled studies are necessary to confirm its role in standard treatment protocols.