Researcher(s)
- Naveena Rajeev, Medical Diagnostics, University of Delaware
Faculty Mentor(s)
- , , University of Delaware
Abstract
Middle Meningeal Artery Embolization Enhances Treatment Durability in Chronic Subdural Hematomas
Naveena Rajeev, Rahil Kheirkhah, DO PhD, John Getchell RN, Asanthi Ratnasekera DO FACS
Background: The incidence of chronic SDHs has significantly increased, largely due to an aging population and an increased use of anticoagulation. Middle meningeal artery embolization (MMAe) has emerged as a new minimally invasive adjunct to surgical decompression and is associated with statistically significant lower rates of SDH recurrence. The objective of this study was to assess treatment failures after MMAe procedures and help determine high risk patients that may require additional surgical decompression.
Methods: A 5-year retrospective review was conducted of patients who had chronic SDH who underwent MMAe. Patients were categorized into three groups: MMAe only at index hospitalization (Primary), MMAe for rebleeding post-surgical intervention at a subsequent admission (Refractory) and combined surgical intervention and MMAe at index hospitalization (Adjunctive). The primary outcome was treatment failure, defined as recurrent bleeding necessitating further procedures. Initial data was for MMA subject description, currently data collection of patients with cSDH who were not treated under MA is being collected as control and baseline information.
Results: A total of 181 patients were included: 29 patients in the Primary cohort, 22 in the Refractory cohort, and 130 in the Adjunctive cohort. Incidence of failure was 13.8% in Primary, 18.2% in Refractory, and 6.9% in the Adjunctive cohorts. 622 cSDH patients who did not undergo MMAe are in ongoing data collection to establish baseline and controls.
Conclusions: Our preliminary findings confirm that lower rates of recurrent subdural hematomas are seen in patients that undergo surgical evacuation of SDH with adjunctive MMA embolization. Ongoing data collection will allow for an assessment of MMAe intervention versus historical norms.
