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

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 cha...

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Autores principales: Liebert, Adrian, Voit-Höhne, Heinz, Ritter, Leonard, Eibl, Thomas, Hammer, Alexander, Städt, Michael, Eff, Florian, Holtmannspötter, Markus, Steiner, Hans-Herbert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10319706/
https://www.ncbi.nlm.nih.gov/pubmed/37247035
http://dx.doi.org/10.1007/s00701-023-05621-7
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author Liebert, Adrian
Voit-Höhne, Heinz
Ritter, Leonard
Eibl, Thomas
Hammer, Alexander
Städt, Michael
Eff, Florian
Holtmannspötter, Markus
Steiner, Hans-Herbert
author_facet Liebert, Adrian
Voit-Höhne, Heinz
Ritter, Leonard
Eibl, Thomas
Hammer, Alexander
Städt, Michael
Eff, Florian
Holtmannspötter, Markus
Steiner, Hans-Herbert
author_sort Liebert, Adrian
collection PubMed
description 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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spelling pubmed-103197062023-07-06 Embolization of the middle meningeal artery vs. second surgery—treatment response and volume course of recurrent chronic subdural hematomas Liebert, Adrian Voit-Höhne, Heinz Ritter, Leonard Eibl, Thomas Hammer, Alexander Städt, Michael Eff, Florian Holtmannspötter, Markus Steiner, Hans-Herbert Acta Neurochir (Wien) Original Article 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. Springer Vienna 2023-05-29 2023 /pmc/articles/PMC10319706/ /pubmed/37247035 http://dx.doi.org/10.1007/s00701-023-05621-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Liebert, Adrian
Voit-Höhne, Heinz
Ritter, Leonard
Eibl, Thomas
Hammer, Alexander
Städt, Michael
Eff, Florian
Holtmannspötter, Markus
Steiner, Hans-Herbert
Embolization of the middle meningeal artery vs. second surgery—treatment response and volume course of recurrent chronic subdural hematomas
title Embolization of the middle meningeal artery vs. second surgery—treatment response and volume course of recurrent chronic subdural hematomas
title_full Embolization of the middle meningeal artery vs. second surgery—treatment response and volume course of recurrent chronic subdural hematomas
title_fullStr Embolization of the middle meningeal artery vs. second surgery—treatment response and volume course of recurrent chronic subdural hematomas
title_full_unstemmed Embolization of the middle meningeal artery vs. second surgery—treatment response and volume course of recurrent chronic subdural hematomas
title_short Embolization of the middle meningeal artery vs. second surgery—treatment response and volume course of recurrent chronic subdural hematomas
title_sort embolization of the middle meningeal artery vs. second surgery—treatment response and volume course of recurrent chronic subdural hematomas
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10319706/
https://www.ncbi.nlm.nih.gov/pubmed/37247035
http://dx.doi.org/10.1007/s00701-023-05621-7
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