Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Helical coils augment embolization of the middle meningeal artery for treatment of chronic subdural hematoma: A technical note

  • Arvin R. Wali (Department of Neurological Surgery, University of California, San Diego) ;
  • Alexander Himstead (Department of Neurological Surgery, University of California, San Diego) ;
  • Javier Bravo (Department of Neurological Surgery, University of California, San Diego) ;
  • Michael G. Brandel (Department of Neurological Surgery, University of California, San Diego) ;
  • Brian R. Hirshman (Department of Neurological Surgery, University of California, San Diego) ;
  • J. Scott Pannell (Department of Neurological Surgery, University of California, San Diego) ;
  • Andrew D. Nguyen (Department of Neurological Surgery, University of California, San Diego) ;
  • David R. Santiago-Dieppa (Department of Neurological Surgery, University of California, San Diego)
  • Received : 2022.07.31
  • Accepted : 2022.12.02
  • Published : 2023.06.30
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Abstract

Embolization of the middle meningeal artery (MMA) is a safe and effective adjunct in the treatment of chronic subdural hematoma. While prior authors describe the use of coils to assist embolization by preventing reflux through eloquent collaterals, we de- scribe the use of coils to further open the MMA, allowing the administration of greater amounts of embolisate for a more robust embolization. The objective of this study was to demonstrate that helical coils can safely open the MMA following the administration of polyvinyl alcohol (PVA) particles. This allows for more embolisate to be administered into the MMA for more effective treatment. A retrospective review was conducted at our institution including intraoperative images and postoperative clinical and radiographic follow up. Failure rates using MMA embolization with PVA and helical coil augmentation were compared to failure rates in the literature of MMA embolization with PVA or ethylene vinyl-alcohol copolymer alone. A total of 8 cases were reviewed in which this technique was implemented. There were no immediate complications after treatment. All patients that underwent helical coil embolization following the administration of PVA had increased amount of embolisate delivered into the MMA. All patients at follow up had resolution of the subdural hematoma on outpatient imaging. Helical coil embolization allows for more embolisate administration into the MMA and provides a technical advantage for patients that fail traditional techniques of embolization. Case series are taking place to further test this hypothesis and identify the ideal patient population that may gain maximal yield from this novel technique.

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References

  1. Balser D, Farooq S, Mehmood T, Reyes M, Samadani U. Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg. 2015 Nov;123(5):1209-15. 
  2. Ban SP, Hwang G, Byoun HS, Kim T, Lee SU, Bang JS, et al. Middle meningeal artery embolization for chronic subdural hematoma. Radiology. 2018 Mar;286(3):992-9. 
  3. Catapano JS, Ducruet AF, Nguyen CL, Baranoski JF, Cole TS, Majmundar N, et al. Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis. J Neurointerv Surg. 2021Jul;13(7):657-60. 
  4. Chen JW, Xu JC, Malkasian D, Perez-Rosendahl MA, Tran DK. The mini-craniotomy for cSDH revisited: new perspectives. Front Neurol. 2021 May;12:660885. 
  5. Clinical Trials Database, U.S. National Library of Medicine at the National Institutes of Health. Middle meningeal artery embolization AND chronic subdural hematoma. https://clinicaltrials.gov/ct2/results?term=middle+meningeal+artery+-embolization&cond=chronic+subdural+hematoma&age_v=&gndr=&type=Intr&rslt=&Search=Apply (Accessed 09/25/2021). 
  6. Cofano F, Pesce A, Vercelli G, Mammi M, Massara A, Minardi M, et al. Risk of recurrence of chronic subdural hematomas after surgery: a multicenter observational cohort study. Front Neurol. 2020 Nov;11:560269. 
  7. Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KL, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation. 2017 May;14(1):108. 
  8. Gilligan J, Gologorsky Y. Middle meningeal artery embolization for chronic subdural hematoma: current state and future directions. World Neurosurg. 2020 Jul;139:622-3. 
  9. Gomez-Paz S, Akamatsu Y, Salem MM, Enriquez-Marulanda A, Robinson TM, Ogilvy CS, et al. Upfront middle meningeal artery embolization for treatment of chronic subdural hematomas in patients with or without midline shift. Interv Neuroradiol. 2021 Aug;27(4):571-6. 
  10. Hashimoto T, Ohashi T, Watanabe D, Koyama S, Namatame H, Izawa H, et al. Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas. Surg Neurol Int. 2013 Aug;4:104. 
  11. Holl DC, Volovici V, Dirven CMF, Peul WC, van Kooten F, Jellema K, et al. Pathophysiology and nonsurgical treatment of chronic subdural hematoma: from past to present to future. World Neurosurg. 2018 Aug;116:402-11.e2. 
  12. Ironside N, Nguyen C, Do Q, Ugiliweneza B, Chen CJ, Sieg EP, et al. Middle meningeal artery embolization for chronic subdural hematoma: a systematic review and meta-analysis. J Neurointerv Surg. 2021 Oct;13(10):951-7. 
  13. Jung YG, Jung NY, Kim E. Independent predictors for recurrence of chronic subdural hematoma. J Korean Neurosurg Soc. 2015 Apr;57(4):266-70. 
  14. Kan P, Maragkos GA, Srivatsan A, Srinivasan V, Johnson J, Burkhardt J, et al. Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations. Neurosurgery. 2021 Jan;88(2):268-77. 
  15. Khorasanizadeh M, Salih M, Harris D, Ogilvy CS. Technique to "trap" a segment of the middle meningeal artery for embolization of a carotid cavernous fistula: 2-dimensional operative video. Oper Neurosurg (Hagerstown). 2021 Oct 13;21(5):e444. 
  16. Kim E. Embolization therapy for refractory hemorrhage in patients with chronic subdural hematomas. World Neurosurg. 2017 May;101:520-7. 
  17. Leroy HA, Aboukais R, Reyns N, Bourgeois P, Labreuche J, Duhamel A, et al. Predictors of functional outcomes and recurrence of chronic subdural hematomas. J Clin Neurosci. 2015 Dec;22(12):1895-900. 
  18. Link TW, Boddu S, Marcus J, Rapoport BI, Lavi E, Knopman J. Middle meningeal artery embolization as treatment for chronic subdural hematoma: a case series. Oper Neurosurg (Hagerstown). 2018 May;14(5):556-62. 
  19. Link TW, Boddu S, Paine SM, Kamel H, Knopman J. Middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases. Neurosurgery. 2019 Dec;85(6): 801-7. 
  20. Link TW, Rapoport BI, Paine SM, Kamel H, Knopman J. Middle meningeal artery embolization for chronic subdural hematoma: endovascular technique and radiographic findings. Interv Neuroradiol. 2018 Aug;24(4): 455-62. 
  21. Matsumoto H, Hanayama H, Okada T, Sakurai Y, Minami H, Masuda A, et al. Which surgical procedure is effective for refractory chronic subdural hematoma? Analysis of our surgical procedures and literature review. J Clin Neurosci. 2018 May;49:40-7. 
  22. Mishra A, Kumar A, Mathur A, Kumar V, Sreen A. Coil assisted glue embolization to improve safety and accuracy in endovascular management of Vein of Galen patients. Clin Neurol Neurosurg. 2021 Apr;205:106652. 
  23. Moshayedi P, Liebeskind DS. Middle meningeal artery embolization in chronic subdural hematoma: implications of pathophysiology in trial design. Front Neurol. 2020 Aug;11:923. 
  24. Ng S, Derraz I, Boetto J, Dargazanli C, Poulen G, Gascou G, et al. Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption. J Neurointerv Surg. 2020 Jul;12(7):695-9. 
  25. Nia AM, Srinivasan VM, Lall RR, Kan P. Middle meningeal artery embolization for chronic subdural hematoma: a national database study of 191 patients in the united states. World Neurosurg. 2021 Sep;153:e300-7. 
  26. Peng D, Zhu Y. External drains versus no drains after burr-hole evacuation for the treatment of chronic subdural haematoma in adults. Cochrane Database Syst Rev. 2016 Aug;2016(8):CD011402. 
  27. Rutledge C, Baranoski JF, Catapano JS, Jadhav AP, Albuquerque FC, Ducruet AF. Resolution of an enlarging subdural haematoma after contralateral middle meningeal artery embolisation. BMJ Case Rep. 2021 Apr;14(4):e017530. 
  28. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet. 2009 Sep;374(9695):1067-73. 
  29. Shotar E, Meyblum L, Premat K, Lenck S, Degos V, Grand T, et al. Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma. J Neurointerv Surg. 2020 Dec;12(12):1209-13. 
  30. Sjavik K, Bartek J Jr, Sagberg LM, Henriksen ML, Gulati S, Stahl FL, et al. Assessment of drainage techniques for evacuation of chronic subdural hematoma: a consecutive population-based comparative cohort study. J Neurosurg. 2017 Jun;133(4):1113-9. 
  31. Sousa EB, Brandao LFS, Tavares CB, Borges IBC, Neto NGF, Kessler IM. Epidemiological characteristics of 778 patients who underwent surgical drainage of chronic subdural hematomas in Brasilia, Brazil. BMC Surg. 2013 Mar;13:5. 
  32. Tamura R, Sato M, Yoshida K, Toda M. History and current progress of chronic subdural hematoma. J Neurol Sci. 2021 Oct 15;429:118066. 
  33. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery. 2008 Dec;63(6):1125-9; discussion 1129. 
  34. Xu C, Zhu Y. External drains versus no, Yang X, Wei M, et al. Randomized controlled study on the curative effects of twist-drill craniotomy and burr-hole craniotomy in the treatment of chronic subdural hematoma. Exp Ther Med. 2018 Aug;16(2):959-65. 
  35. Yadav YR, Parihar V, Namdev H, Bajaj J. Chronic subdural hematoma. Asian J Neurosurg. 2016 Oct-Dec;11(4):330-42. 
  36. Yang W, Huang J. Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am. 2017 Apr;28(2):205-10.