Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
권호 표지
DOI QR코드

DOI QR Code

Safety of middle meningeal artery embolization for treatment of subdural hematoma: A nationwide propensity score matched analysis

  • Carson P. McCann (Department of Neurosurgery, University of California) ;
  • Michael G. Brandel (Department of Neurosurgery, University of California) ;
  • Arvin R. Wali (Department of Neurosurgery, University of California) ;
  • Jeffrey A. Steinberg (Department of Neurosurgery, University of California) ;
  • J. Scott Pannell (Department of Neurosurgery, University of California) ;
  • David R. Santiago-Dieppa (Department of Neurosurgery, University of California) ;
  • Alexander A. Khalessi (Department of Neurosurgery, University of California)
  • Received : 2023.05.11
  • Accepted : 2023.06.20
  • Published : 2023.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: Middle meningeal artery embolization (MMAe) has burgeoned as a treatment for chronic subdural hematoma (cSDH). This study evaluates the safety and short-term outcomes of MMAe patients relative to traditional treatment approaches. Methods: In this retrospective large database study, adult patients in the National Inpatient Sample from 2012-2019 with a diagnosis of cSDH were identified. Cost of admission, length of stay (LOS), discharge disposition, and complications were analyzed. Propensity score matching (PSM) was utilized. Results: A total of 123,350 patients with cSDH were identified: 63,450 without intervention, 59,435 surgery only, 295 MMAe only, and 170 surgery plus MMAe. On PSM analysis, MMAe did not increase the risk of inpatient complications or prolong the length of stay compared to conservative management (p>0.05); MMAe had higher cost ($31,170 vs. $10,768, p<0.001) than conservative management, and a lower rate of nonroutine discharge (53.8% vs. 64.3%, p=0.024). Compared to surgery, MMAe had shorter LOS (5 vs. 7 days, p<0.001), and lower rates of neurological complications (2.7% vs. 7.1%, p=0.029) and nonroutine discharge (53.8% vs. 71.7%, p<0.001). There was no significant difference in cost (p>0.05). Conclusions: MMAe had similar LOS and decreased odds of adverse discharge with a modest cost increase compared to conservative management. There was no difference in inpatient complications. Compared to surgery, MMAe treatment was associated with decreased LOS and rates of neurological complications and nonroutine discharge. This nationwide analysis supports the safety of MMAe to treat cSDH.

Keywords

References

  1. Agency for Healthcare Research and Quality. HCUP National Inpatient Sample (NIS). in (HCUP) HCaUP, Rockville, MD, 2012-2019.
  2. Aspegren OP, Astrand R, Lundgren MI, Romner B. Anticoagulation therapy a risk factor for the development of chronic subdural hematoma. Clin Neurol Neurosurg. 2013 Jul;115(7):981-4. https://doi.org/10.1016/j.clineuro.2012.10.008
  3. 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. https://doi.org/10.3171/2014.9.JNS141550
  4. Dicpinigaitis AJ, Al-Mufti F, Cooper JB, Kazim SF, Couldwell WT, Schmidt MH, et al. Nationwide trends in middle meningeal artery embolization for treatment of chronic subdural hematoma: A population-based analysis of utilization and short-term outcomes. J Clin Neurosci. 2021 Dec;94:70-5. https://doi.org/10.1016/j.jocn.2021.10.001
  5. Dobran M, Marini A, Nasi D, Liverotti V, Benigni R, Costanza MD, et al. Clinical outcome of patients over 90 years of age treated for chronic subdural hematoma. J Korean Neurosurg Soc. 2022 Jan;65(1):123-9. https://doi.org/10.3340/jkns.2018.0011
  6. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998 Jan;36(1):8-27. https://doi.org/10.1097/00005650-199801000-00004
  7. Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Yi HJ. Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma. J Neurosurg. 2017 Nov;127(5):1117-25. https://doi.org/10.3171/2016.8.JNS16867
  8. 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. https://doi.org/10.1016/j.wneu.2018.05.037
  9. 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. https://doi.org/10.1136/neurintsurg-2021-017352
  10. Joyce E, Bounajem MT, Scoville J, Thomas AJ, Ogilvy CS, Riina HA, et al. Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: A multiinstitutional experience of 151 cases. Neurosurg Focus. 2020 Oct;49(4):e5.
  11. Khera R, Angraal S, Couch T, Welsh JW, Nallamothu BK, Girotra S, et al. Adherence to methodological standards in research using the national inpatient sample. JAMA. 2017 Nov;318(20):2011-18. https://doi.org/10.1001/jama.2017.17653
  12. Knopman J, Link TW, Navi BB, Murthy SB, Merkler AE, Kamel H. Rates of repeated operation for isolated subdural hematoma among older adults. JAMA Netw Open. 2018 Oct;1(6):e183737
  13. Lakomkin N, Graffeo CS, Hadjipanayis CG. Specific causes and predictors of readmissions following acute and chronic subdural hematoma evacuation. J Clin Neurosci. 2020 May; 75:35-9. https://doi.org/10.1016/j.jocn.2020.03.042
  14. 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. https://doi.org/10.1016/j.wneu.2021.06.101
  15. Nouri A, Gondar R, Schaller K, Meling T. Chronic Subdural Hematoma (cSDH): A review of the current state of the art. Brain Spine. 2021 Nov;1:100300.
  16. Rauhala M, Helen P, Seppa K, Huhtala H, Iverson GL, Niskakangas T, et al. Long-term excess mortality after chronic subdural hematoma. Acta Neurochir (Wien). 2020 Jun;162(6):1467-78. https://doi.org/10.1007/s00701-020-04278-w
  17. Rauhala M, Luoto TM, Huhtala H, Iverson GL, Niskakangas T, Ohman J, et al. The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population. J Neurosurg. 2019 Mar;132(4):1147-57. https://doi.org/10.3171/2018.12.JNS183035
  18. Srivatsan A, Mohanty A, Nascimento FA, Hafeez MU, Srinivasan VM, Thomas A, et al. Middle meningeal artery embolization for chronic subdural hematoma: Meta-analysis and systematic review. World Neurosurg. 2019 Feb;122:613-9. https://doi.org/10.1016/j.wneu.2018.11.167
  19. Takizawa K, Sorimachi T, Ishizaka H, Osada T, Srivatanakul K, Momose H, et al. Enlargement of the middle meningeal artery on MR angiography in chronic subdural hematoma. J Neurosurg. 2016 Jun;124(6):1679-83. https://doi.org/10.3171/2015.5.JNS1567
  20. Weigel R, Schilling L, Krauss JK. The pathophysiology of chronic subdural hematoma revisited: Emphasis on aging processes as key factor. Geroscience. 2022 Jun;44(3):1353-71. https://doi.org/10.1007/s11357-022-00570-y
  21. Yoshihara H, Yoneoka D. Understanding the statistics and limitations of large database analyses. Spine (Phila Pa 1976). 2014 Jul;39(16):1311-2. https://doi.org/10.1097/BRS.0000000000000352