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Open Access 29-05-2023 | Hematoma | Original Article

Embolization of the middle meningeal artery vs. second surgery—treatment response and volume course of recurrent chronic subdural hematomas

Authors: Adrian Liebert, Heinz Voit-Höhne, Leonard Ritter, Thomas Eibl, Alexander Hammer, Michael Städt, Florian Eff, Markus Holtmannspötter, Hans-Herbert Steiner

Published in: Acta Neurochirurgica | Issue 7/2023

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Abstract

Background

Despite multiple studies on the embolization of the middle meningeal artery, there is limited data on the treatment response of recurrent chronic subdural hematomas (CSDH) to embolization and on the volume change.

Methods

We retrospectively compared the treatment response and volume change of recurrent CSDHs in a conventional group (second surgery) with an embolization group (embolization as stand-alone treatment) during the time-period from August 2019 until June 2022. Different clinical and radiological factors were assessed. Treatment failure was defined as necessity of treatment for second recurrence. Hematoma volumes were determined in the initial CT scan before first surgery, after the first surgery, before retreatment as well as in an early (1 day–2 weeks) and in a late follow-up CT scan (2–8 weeks).

Results

Fifty recurrent hematomas after initial surgery were treated either by second surgery (n = 27) or by embolization (n = 23). 8/27 (26,6%) surgically treated and 3/23 (13%) of the hematomas treated by embolization needed to be treated again. This leads to an efficacy in recurrent hematomas of 73,4% in surgically treated and of 87% in embolized hematomas (p = 0.189). In the conventional group, mean volume decreased significantly already in the first follow-up CT scan from 101.7 ml (SD 53.7) to 60.7 ml (SD 40.3) (p = 0.001) and dropped further in the later follow-up scan to 46.6 ml (SD 37.1) (p = 0.001). In the embolization group, the mean volume did decrease insignificantly from 75.1 ml (SD 27.3) to 68 ml (SD 31.4) in the first scan (p = 0.062). However, in the late scan significant volume reduction to 30.8 ml (SD 17.1) could be observed (p = 0.002).

Conclusions

Embolization of the middle meningeal artery is an effective treatment option for recurrent CSDH. Patients with mild symptoms who can tolerate slow volume reduction are suitable for embolization, whereas patients with severe symptoms should be reserved for surgery.
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Metadata
Title
Embolization of the middle meningeal artery vs. second surgery—treatment response and volume course of recurrent chronic subdural hematomas
Authors
Adrian Liebert
Heinz Voit-Höhne
Leonard Ritter
Thomas Eibl
Alexander Hammer
Michael Städt
Florian Eff
Markus Holtmannspötter
Hans-Herbert Steiner
Publication date
29-05-2023
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 7/2023
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-023-05621-7

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