Comparison of adjunctive middle meningeal artery embolization using embosphere particles versus surgical drainage alone for the treatment of chronic subdural hematoma: A prospective study

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2024-08-22 DOI:10.1016/j.jocn.2024.110808

Gahn Duangprasert, Sasikan Sukhor, Raywat Noiphithak , Dilok Tantongtip

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引用次数: 0

Abstract

Background

Middle meningeal artery embolization (MMAE) has emerged as a primary and adjunctive therapy for chronic subdural hematoma (CSDH) in addition to conventional treatment. However, there is a scarcity of data that explicitly compares the effectiveness of adjunctive MMAE to surgical drainage alone (SDA), as well as the use of Embosphere particles. The objective of this study was to assess the safety and efficacy of adjunctive MMAE in the treatment of symptomatic CSDH compared to SDA.

Methods

This prospective study included 43 patients with 52 CSDH sides, treated at a single institution between 2022 and 2023. The primary outcome was postoperative hematoma volume at 14, 30, 90, and 180 days after surgical drainage, which was analyzed using the generalized estimating equation. The secondary outcomes were the complications and recurrence/reoperation rate. Adjunctive MMAE was performed within 7 days following the surgery, utilizing Embosphere as the embolic material.

Results

The patients were assigned to either the adjunctive MMAE group (n = 20, 26 CSDH sides) or the SDA group (n = 23, 26 CSDH sides). The adjunctive MMAE group demonstrated a more significant reduction in hematoma volume (p = 0.007) and maximal hematoma thickness (p = 0.016) at all follow-up intervals. A trend towards lower recurrence and reoperation rates was observed with adjunctive MMAE; particularly, none of the patients in the adjunctive MMAE group experienced a recurrence of CSDH, compared to 19.2 % in the SDA group (p = 0.051). One procedural-related complication (3.8 %) in the adjunctive MMAE group.

Conclusion

Our results suggested that adjunctive MMAE, compared to SDA, may enhance hematoma resolution and reduce the need for reoperation due to recurrence.

查看原文本刊更多论文

使用栓塞球微粒辅助脑膜中动脉栓塞与单纯手术引流治疗慢性硬膜下血肿的比较：一项前瞻性研究

背景脑膜中动脉栓塞术（MMAE）已成为慢性硬膜下血肿（CSDH）常规治疗之外的主要疗法和辅助疗法。然而，明确比较辅助性 MMAE 和单纯手术引流 (SDA) 以及使用 Embosphere 粒子的有效性的数据并不多见。本研究的目的是评估辅助 MMAE 治疗无症状 CSDH 的安全性和有效性，并与 SDA 进行比较。主要结果是手术引流后14天、30天、90天和180天的术后血肿量，采用广义估计方程进行分析。次要结果是并发症和复发/手术率。结果患者被分配到辅助 MMAE 组（n = 20，26 个 CSDH 侧）或 SDA 组（n = 23，26 个 CSDH 侧）。在所有随访时间间隔内，辅助 MMAE 组的血肿体积（p = 0.007）和最大血肿厚度（p = 0.016）均有更显著的减少。据观察，辅助 MMAE 有降低复发率和再手术率的趋势；特别是，辅助 MMAE 组患者中没有一人出现 CSDH 复发，而 SDA 组的复发率为 19.2%（p = 0.051）。结论我们的研究结果表明，与 SDA 相比，辅助 MMAE 可提高血肿清除率，减少因复发而再次手术的需要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.