Chronic Subdural Medical Management

Analysis of middle meningeal artery embolization for the treatment of chronic, acute on chronic, and subacute subdural hematomas

Background

Chronic subdural hematoma (cSDH) is a common sequela of traumatic brain injury. Middle meningeal artery embolization (MMAE) has shown promising results as an emerging minimally invasive alternative treatment. The purpose of this study is to examine the safety and efficacy of MMAE performed in patients with cSDH, acute-on-chronic, and subacute SDH with a traumatic etiology.

Methods

This retrospective study included cases performed at a Level II Trauma Center between January 2019 and December 2020 for MMAE of cSDHs. Data collected included patient demographic characteristics and comorbidities, SDH characteristics, complications, and efficacy outcomes. The lesion measurements were collected before the procedure, 4-6 weeks and 3-6 months post-procedure.

Results

In our patient population, 78% (39) either had lesions improve or completely resolved. The sample included 50 patients with a mean age of 74 years old. Statistically significant reductions in lesion size were found from pre- to post-procedure in the left lesions, right lesions, and midline shifts. The left lesions decreased from 13.88 ± 5.70 mm to 3.19 ± 4.89 mm at 3-6 months with P < 0.001. The right lesions decreased from 13.74 ± 5.28 mm to 4.93 ± 7.46 mm at 3-6 months with P = 0.02. Midline shifts decreased from 3.78 ± 3.98 mm to 0.48 ± 1.31 mm at 3-6 months with P = 0.02. No complications were experienced for bleeding, hematoma, worsening SDH, pseudoaneurysm, or stroke.

Conclusion

Our pilot study from a single center utilizing MMAE demonstrates that MMAE is successful without increasing treatment-related complications not only for cSDH but also in acute-on-cSDH and SDH with a subacute component.

Controversies in the Surgical Treatment of Chronic Subdural Hematoma: A Systematic Scoping Review

Chronic subdural hematoma (cSDH) is one of the most common neurosurgical entities, especially in the elderly population. Diagnosis is usually established via a head computed tomography, while an increasing number of studies are investigating biomarkers to predict the natural history of cSDH, including progression and recurrence. Surgical evacuation remains the mainstay of treatment in the overwhelming majority of cases. Nevertheless, many controversies are associated with the nuances of surgical treatment. We performed a systematic review of the literature between 2010 and 2022, aiming to identify and address the issues in cSDH surgical management where consensus is lacking. The results show ambiguous data in regard to indication, the timing and type of surgery, the duration of drainage, concomitant membranectomy and the need for embolization of the middle meningeal artery. Other aspects of surgical treatment-such as the use of drainage and its location and number of burr holes-seem to have been adequately clarified: the drainage of hematoma is strongly recommended and the outcome is considered as independent of drainage location or the number of burr holes.

The therapeutic effects of craniotomy versus endoscopic-assisted trepanation drainage for isolated chronic subdural haematoma (ICSH): A single-centre long-term retrospective comparison study

BACKGROUND

Isolated chronic subdural hematoma (ICSH), as a special rare species, has great controversy over its treatment. A retrospective analysis was performed to compare craniotomy with endoscopic-assisted trepanation drainage (EATD) of ICSH.

METHODS

The data of ICSH patients for craniotomy or EATD from January 2011 to April 2019 were retrospectively collected and analysed. Of 106 patients, 49 and 57 patients received craniotomy and EATD treatment respectively. Recurrence rate, morbidity and mortality rate were the main outcome.

RESULT

There was no recurrence in both groups. The morbidity rate of the EATD group (2/57, 3.5%) was significantly lower than that of the craniotomy group (17/49, 34.7%, p = 0.0033). There was no death in the EATD group, but 3 cases died of operative produce in the craniotomy group. The average operation time of the craniotomy group (95.3min) was significantly longer than that of the EATD group (66.5min, P =  0.0032). Craniotomy group had more intraoperative blood loss (213.2ml) than EATD group (34.5ml, P = 0.0044). EATD patients had shorter hospital stay and recovered faster.

CONCLUSIONS

Compared with craniotomy, EATD is a more effective and safer method for the treatment of ICSH.

WITHDRAWN: The Optimal Treatment Options of Septated Chronic Subdural Hematoma: A Retrospective Comparison of Craniotomy Versus Endoscopic-Assisted Burr-Hole Craniostomy

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