Li Ma, Samer S Hoz, Mohamed F Doheim, Ali Fadhil, Abdullah Sultany, Alhamza R Al-Bayati, Raul G Nogueira, Michael J Lang, Bradley A Gross
{"title":"中脑膜动脉栓塞治疗 \"不符合试验条件 \"的慢性硬膜下血肿。","authors":"Li Ma, Samer S Hoz, Mohamed F Doheim, Ali Fadhil, Abdullah Sultany, Alhamza R Al-Bayati, Raul G Nogueira, Michael J Lang, Bradley A Gross","doi":"10.1227/neu.0000000000003136","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>The benefit of middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematoma (CSDH) has been recently demonstrated in a series of clinical trials. Whether MMAE benefits \"trial-ineligible\" patients remains elusive. We thus sought to explore the potential benefit of MMAE in neurologically stable (modified Rankin Scale ≤3) patients with \"trial-ineligible\" CSDHs because of large size: Thickness >15 mm and/or midline shift ≥5 mm.</p><p><strong>Methods: </strong>A prospectively maintained database was reviewed to identify trial-ineligible CSDHs undergoing standalone MMAE. Surgical rescue rate, hematoma resolution, and neurological deterioration after hematoma progression were evaluated and compared with trial-eligible counterparts. Effect sizes were adjusted for demographic, clinical, and radiological features using multivariable regression.</p><p><strong>Results: </strong>Of 150 standalone MMAE procedures, 92 (61%) were performed in \"trial-ineligible\" cases: 41% with CSDH thickness >15 mm, 21% with midline shift ≥5 mm, and 38% with both. The surgical rescue rate was 7.6% in the trial-ineligible cohort. Over a median follow-up of 62.5 days, 88.9% cases achieved satisfactory hematoma resolution (≥50% in thickness); 76% had satisfactory resolution at 90-day follow-up. Antithrombotic resumption was a risk factor for surgical rescue (adjusted odds ratio 9.64 [95% CI, 1.33-69.74]; P = .02). Surgical rescue and hematoma resolution did not significantly differ between trial-ineligible and trial-eligible cohorts (P = .87 for surgical rescue rate and P = .85 for hematoma resolution rate).</p><p><strong>Conclusion: </strong>This study emphasizes the considerable prevalence of potentially \"trial-ineligible\" patients with CSDHs because of large size that may still benefit from standalone MMAE.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Middle Meningeal Artery Embolization for \\\"Trial-Ineligible\\\" Chronic Subdural Hematomas.\",\"authors\":\"Li Ma, Samer S Hoz, Mohamed F Doheim, Ali Fadhil, Abdullah Sultany, Alhamza R Al-Bayati, Raul G Nogueira, Michael J Lang, Bradley A Gross\",\"doi\":\"10.1227/neu.0000000000003136\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>The benefit of middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematoma (CSDH) has been recently demonstrated in a series of clinical trials. Whether MMAE benefits \\\"trial-ineligible\\\" patients remains elusive. We thus sought to explore the potential benefit of MMAE in neurologically stable (modified Rankin Scale ≤3) patients with \\\"trial-ineligible\\\" CSDHs because of large size: Thickness >15 mm and/or midline shift ≥5 mm.</p><p><strong>Methods: </strong>A prospectively maintained database was reviewed to identify trial-ineligible CSDHs undergoing standalone MMAE. Surgical rescue rate, hematoma resolution, and neurological deterioration after hematoma progression were evaluated and compared with trial-eligible counterparts. Effect sizes were adjusted for demographic, clinical, and radiological features using multivariable regression.</p><p><strong>Results: </strong>Of 150 standalone MMAE procedures, 92 (61%) were performed in \\\"trial-ineligible\\\" cases: 41% with CSDH thickness >15 mm, 21% with midline shift ≥5 mm, and 38% with both. The surgical rescue rate was 7.6% in the trial-ineligible cohort. Over a median follow-up of 62.5 days, 88.9% cases achieved satisfactory hematoma resolution (≥50% in thickness); 76% had satisfactory resolution at 90-day follow-up. Antithrombotic resumption was a risk factor for surgical rescue (adjusted odds ratio 9.64 [95% CI, 1.33-69.74]; P = .02). Surgical rescue and hematoma resolution did not significantly differ between trial-ineligible and trial-eligible cohorts (P = .87 for surgical rescue rate and P = .85 for hematoma resolution rate).</p><p><strong>Conclusion: </strong>This study emphasizes the considerable prevalence of potentially \\\"trial-ineligible\\\" patients with CSDHs because of large size that may still benefit from standalone MMAE.</p>\",\"PeriodicalId\":19276,\"journal\":{\"name\":\"Neurosurgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-08-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1227/neu.0000000000003136\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1227/neu.0000000000003136","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Middle Meningeal Artery Embolization for "Trial-Ineligible" Chronic Subdural Hematomas.
Background and objectives: The benefit of middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematoma (CSDH) has been recently demonstrated in a series of clinical trials. Whether MMAE benefits "trial-ineligible" patients remains elusive. We thus sought to explore the potential benefit of MMAE in neurologically stable (modified Rankin Scale ≤3) patients with "trial-ineligible" CSDHs because of large size: Thickness >15 mm and/or midline shift ≥5 mm.
Methods: A prospectively maintained database was reviewed to identify trial-ineligible CSDHs undergoing standalone MMAE. Surgical rescue rate, hematoma resolution, and neurological deterioration after hematoma progression were evaluated and compared with trial-eligible counterparts. Effect sizes were adjusted for demographic, clinical, and radiological features using multivariable regression.
Results: Of 150 standalone MMAE procedures, 92 (61%) were performed in "trial-ineligible" cases: 41% with CSDH thickness >15 mm, 21% with midline shift ≥5 mm, and 38% with both. The surgical rescue rate was 7.6% in the trial-ineligible cohort. Over a median follow-up of 62.5 days, 88.9% cases achieved satisfactory hematoma resolution (≥50% in thickness); 76% had satisfactory resolution at 90-day follow-up. Antithrombotic resumption was a risk factor for surgical rescue (adjusted odds ratio 9.64 [95% CI, 1.33-69.74]; P = .02). Surgical rescue and hematoma resolution did not significantly differ between trial-ineligible and trial-eligible cohorts (P = .87 for surgical rescue rate and P = .85 for hematoma resolution rate).
Conclusion: This study emphasizes the considerable prevalence of potentially "trial-ineligible" patients with CSDHs because of large size that may still benefit from standalone MMAE.
期刊介绍:
Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery.
Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.