Safety and Effectiveness of Embolization for Chronic Subdural Hematoma: Systematic Review and Case Series

Muhammad Waqas; Kunal Vakhari; Peter V Weimer; Eisa Hashmi; Jason M Davies; Adnan H Siddiqui

doi:10.1016/j.wneu.2019.02.208

Safety and Effectiveness of Embolization for Chronic Subdural Hematoma: Systematic Review and Case Series

World Neurosurg. 2019 Jun:126:228-236. doi: 10.1016/j.wneu.2019.02.208. Epub 2019 Mar 13.

Authors

Muhammad Waqas¹, Kunal Vakhari¹, Peter V Weimer², Eisa Hashmi², Jason M Davies³, Adnan H Siddiqui⁴

Affiliations

¹ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
² Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
³ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
⁴ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA. Electronic address: asiddiqui@ubns.com.

PMID: 30878752
DOI: 10.1016/j.wneu.2019.02.208

Abstract

Introduction: Embolization of the middle meningeal artery (MMA) has emerged as a minimally invasive means of managing subdural hematoma. The purpose of this study was to systematically review the literature on the safety and effectiveness of this treatment and to share our clinical experience.

Methods: This review was registered with PROSPERO. PubMed, CINAHL, EMBASE, and the Cochrane Library were searched using MeSH (Medical Subject Headings) terms for MMA embolization and chronic subdural hematoma (CSDH) from January 2000 to November 2018. All articles in the English language literature describing MMA embolization for CSDH were included, irrespective of study design. Consecutive patients who underwent MMA embolization at our hospital between January 2017 and June 2018 comprised our clinical experience.

Results: Fifteen studies with 193 procedures were included in the review. Ninety-five cases (49.2%) involved primary MMA embolization; 88 embolizations (45.6%) for recurrent CSDH and 10 (5.2%) for prophylaxis after surgical evacuation were performed. Recurrence after MMA embolization requiring further treatment occurred in 7 cases (3.6%). All other patients had symptomatic relief with no further recurrence. No procedure-related complications were reported. Polyvinyl alcohol was the most commonly used material. Our series included 8 patients treated with Onyx. All had symptom relief and significant reduction in hematoma size; no recurrences or procedure-related complications were observed.

Conclusions: MMA embolization of CSDH is safe and effective for CSDH treatment based on a documented recurrence rate of 3.6% and lack of reported complications.

Keywords: Chronic subdural hematoma; Embolization; Endovascular treatment; Middle meningeal artery.

Publication types

Systematic Review

MeSH terms

Embolization, Therapeutic / adverse effects
Embolization, Therapeutic / methods*
Hematoma, Subdural, Chronic / therapy*
Humans
Treatment Outcome