Atakan Orscelik, Yigit Can Senol, Eli Chaney, Kazim Narsinh, Matthew Amans, Daniel Ms Raper, Ethan Winkler, Steven Hetts, Daniel Cooke, Luis E Savastano
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Data were collected on patient demographics, clinical presentations, imaging findings, treatment approaches, and outcomes. A systematic review was also conducted across PubMed, Web of Science, Scopus, and Embase databases, adhering to PRISMA guidelines.ResultsNon-traumatic recurrent or growing SDHs were associated with MMA recanalization (27%), contralateral supply from the contralateral MMA (27%), CSF-venous fistulas (5%), and recruitments of vascular collaterals such as deep temporal artery (5%). Management strategies included, respectively, repeat MMAe using polyvinyl alcohol particles, coils, and liquid agents; contralateral MMAe, transvenous embolization for CSF-venous fistulas; and targeted embolization for other vascular contributors. Follow-up assessments were available for 14 patients (64%). Of these, 10 patients (45%) achieved complete resolution of symptoms, three patients (14%) experienced symptomatic improvement, and one patient (5%) had worsening symptoms. In terms of hematoma resolution, nine patients (41%) had complete or near-complete resolution, three patients (14%) exhibited stable hematoma size, and two patients (9%) demonstrated a reduction in hematoma size. Notably, no recurrences were observed after the final treatment. Two patients (9%) died within 10 days of the final embolization treatment due to malignancies.ConclusionRecurrent or growing SDHs following MMAe are linked to subdural membrane vascularity and intracranial hypotension which must be investigated and addressed. Treatment of these issues results in high cure rates.</p>","PeriodicalId":49174,"journal":{"name":"Interventional Neuroradiology","volume":" ","pages":"15910199251370600"},"PeriodicalIF":2.1000,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378119/pdf/","citationCount":"0","resultStr":"{\"title\":\"Rescue management of recurrent or growing non-acute subdural hematoma following standalone or adjunctive middle meningeal artery embolization: A case series and systematic review.\",\"authors\":\"Atakan Orscelik, Yigit Can Senol, Eli Chaney, Kazim Narsinh, Matthew Amans, Daniel Ms Raper, Ethan Winkler, Steven Hetts, Daniel Cooke, Luis E Savastano\",\"doi\":\"10.1177/15910199251370600\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>ObjectiveRecurrent or growing non-acute subdural hematoma (SDH) following standalone or adjunctive middle meningeal artery embolization (MMAe) present a complex clinical challenge. This study aims to investigate the multifactorial causes of recurrence and growing SDH, including vascular and systemic contributors, and explores management strategies to improve outcomes.MethodsWe conducted a retrospective analysis of 22 patients with non-acute SDH requiring rescue treatment after adjunctive or stand-alone MMAe. Patients with documented trauma deemed responsible for the SDH expansion were excluded. Data were collected on patient demographics, clinical presentations, imaging findings, treatment approaches, and outcomes. A systematic review was also conducted across PubMed, Web of Science, Scopus, and Embase databases, adhering to PRISMA guidelines.ResultsNon-traumatic recurrent or growing SDHs were associated with MMA recanalization (27%), contralateral supply from the contralateral MMA (27%), CSF-venous fistulas (5%), and recruitments of vascular collaterals such as deep temporal artery (5%). Management strategies included, respectively, repeat MMAe using polyvinyl alcohol particles, coils, and liquid agents; contralateral MMAe, transvenous embolization for CSF-venous fistulas; and targeted embolization for other vascular contributors. Follow-up assessments were available for 14 patients (64%). Of these, 10 patients (45%) achieved complete resolution of symptoms, three patients (14%) experienced symptomatic improvement, and one patient (5%) had worsening symptoms. In terms of hematoma resolution, nine patients (41%) had complete or near-complete resolution, three patients (14%) exhibited stable hematoma size, and two patients (9%) demonstrated a reduction in hematoma size. Notably, no recurrences were observed after the final treatment. Two patients (9%) died within 10 days of the final embolization treatment due to malignancies.ConclusionRecurrent or growing SDHs following MMAe are linked to subdural membrane vascularity and intracranial hypotension which must be investigated and addressed. Treatment of these issues results in high cure rates.</p>\",\"PeriodicalId\":49174,\"journal\":{\"name\":\"Interventional Neuroradiology\",\"volume\":\" \",\"pages\":\"15910199251370600\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-08-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378119/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Interventional Neuroradiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/15910199251370600\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Interventional Neuroradiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/15910199251370600","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的单独或辅助脑膜中动脉栓塞术(MMAe)后当前或正在发展的非急性硬膜下血肿(SDH)是一个复杂的临床挑战。本研究旨在探讨SDH复发和增长的多因素原因,包括血管和系统因素,并探讨改善预后的管理策略。方法回顾性分析22例在辅助或独立MMAe后需要抢救治疗的非急性SDH患者。被认为是造成SDH扩张的创伤记录的患者被排除在外。收集了患者人口统计学、临床表现、影像学表现、治疗方法和结果的数据。遵循PRISMA指南,对PubMed、Web of Science、Scopus和Embase数据库进行了系统评价。结果非外伤性复发或生长的sdh与MMA再通(27%)、对侧MMA对侧供应(27%)、csf静脉瘘(5%)和颞深动脉等血管侧支的募集(5%)有关。管理策略包括分别使用聚乙烯醇颗粒、线圈和液体剂重复MMAe;对侧MMAe,经静脉栓塞治疗csf -静脉瘘;对其他血管供血源进行靶向栓塞。14例(64%)患者进行了随访评估。其中,10名患者(45%)症状完全缓解,3名患者(14%)症状改善,1名患者(5%)症状加重。在血肿消退方面,9例患者(41%)完全或接近完全消退,3例患者(14%)血肿大小稳定,2例患者(9%)血肿大小减小。值得注意的是,在最终治疗后没有观察到复发。2例患者(9%)在最后栓塞治疗后10天内因恶性肿瘤死亡。结论MMAe术后复发或生长的sdh与硬膜下血管和颅内低血压有关,应予以重视。这些问题的治疗导致高治愈率。
Rescue management of recurrent or growing non-acute subdural hematoma following standalone or adjunctive middle meningeal artery embolization: A case series and systematic review.
ObjectiveRecurrent or growing non-acute subdural hematoma (SDH) following standalone or adjunctive middle meningeal artery embolization (MMAe) present a complex clinical challenge. This study aims to investigate the multifactorial causes of recurrence and growing SDH, including vascular and systemic contributors, and explores management strategies to improve outcomes.MethodsWe conducted a retrospective analysis of 22 patients with non-acute SDH requiring rescue treatment after adjunctive or stand-alone MMAe. Patients with documented trauma deemed responsible for the SDH expansion were excluded. Data were collected on patient demographics, clinical presentations, imaging findings, treatment approaches, and outcomes. A systematic review was also conducted across PubMed, Web of Science, Scopus, and Embase databases, adhering to PRISMA guidelines.ResultsNon-traumatic recurrent or growing SDHs were associated with MMA recanalization (27%), contralateral supply from the contralateral MMA (27%), CSF-venous fistulas (5%), and recruitments of vascular collaterals such as deep temporal artery (5%). Management strategies included, respectively, repeat MMAe using polyvinyl alcohol particles, coils, and liquid agents; contralateral MMAe, transvenous embolization for CSF-venous fistulas; and targeted embolization for other vascular contributors. Follow-up assessments were available for 14 patients (64%). Of these, 10 patients (45%) achieved complete resolution of symptoms, three patients (14%) experienced symptomatic improvement, and one patient (5%) had worsening symptoms. In terms of hematoma resolution, nine patients (41%) had complete or near-complete resolution, three patients (14%) exhibited stable hematoma size, and two patients (9%) demonstrated a reduction in hematoma size. Notably, no recurrences were observed after the final treatment. Two patients (9%) died within 10 days of the final embolization treatment due to malignancies.ConclusionRecurrent or growing SDHs following MMAe are linked to subdural membrane vascularity and intracranial hypotension which must be investigated and addressed. Treatment of these issues results in high cure rates.
期刊介绍:
Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...