Journal of Cerebrovascular and Endovascular Neurosurgery

  • 제25권1호
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  • Pages.28-35
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  • 2023
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  • 2234-8565(pISSN)
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  • 2287-3139(eISSN)
대한뇌혈관외과학회 (Korean Society of Cerebravascular Surgeons)
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Middle meningeal artery embolization for chronic subdural hematoma in elderly patients at high risk of surgical treatment

  • Jin Hoo Seok (Department of Neurosurgery, Korea University Guro Hospital) ;
  • Jong Hyun Kim (Department of Neurosurgery, Korea University Guro Hospital) ;
  • Taek Hyun Kwon (Department of Neurosurgery, Korea University Guro Hospital) ;
  • Joonho Byun (Department of Neurosurgery, Korea University Guro Hospital) ;
  • Won Ki Yoon (Department of Neurosurgery, Korea University Guro Hospital)
  • 투고 : 2022.08.19
  • 심사 : 2022.09.23
  • 발행 : 2023.03.31
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초록

Objective: The purpose of this study was to evaluate the effectiveness of middle meningeal artery embolization (MMAE) in elderly high-risk patients with symptomatic chronic subdural hematoma (CSDH) in terms of reduction in hematoma volume and recurrence rate. Methods: We retrospectively reviewed data prospectively collected from nine patients who underwent 13 MMAE for CSDH between June 2017 and May 2022. The volume of the subdural hematoma was measured using a computer-aided volumetric analysis program. Hematoma volume changes during the follow-up period were analyzed and clinical outcomes were evaluated. Results: The mean follow-up period was 160 days (range, 46-311 days). All procedures were technically successful and there were no procedure-related complications. Of the 13 MMAE, 84% (11 out of 13 hemispheres) showed mean 88% of reduction on follow-up volumetric study with eight cases of complete resolution. There was one refractory case with MMAE which had been performed multiple burr-hole trephinations, for which treatment was completed by craniotomy and meticulous resection of multiple pseudomembranes. There was no recurrent case during the follow-up period, except for refractory case. Conclusions: MMAE for CSDH in selected high-risk elderly patients and relapsed patients might be effective. Despite the small cohort, our findings showed a high rate of complete resolution with no complications. Further prospective randomized trials are warranted to evaluate its usefulness as a primary treatment option for CSDH.

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참고문헌

  1. Almenawer SA, Farrokhyar F, Hong C, Alhazzani W, Manoranjan B, Yarascavitch B, et al. Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg. 2014 Mar;259(3):449-57. https://doi.org/10.1097/SLA.0000000000000255
  2. 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
  3. 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. https://doi.org/10.1148/radiol.2017170053
  4. Bokka S, Trivedi A. Histopathological study of the outer membrane of the dura mater in chronic sub dural hematoma: its clinical and radiological correlation. Asian J Neurosurg. 2016 Jan-Mar;11(1):34-8. https://doi.org/10.4103/1793-5482.154979
  5. Borger V, Vatter H, Oszvald A, Marquardt G, Seifert V, Guresir E. Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65-94 years. Acta Neurochir (Wien). 2012 Sep;154(9):1549-54. https://doi.org/10.1007/s00701-012-1434-x
  6. Foreman P, Goren O, Griessenauer CJ, Dalal SS, Weiner G, Schirmer CM. Middle meningeal artery embolization for chronic subdural hematomas: cautious optimism for a challenging pathology. World Neurosurg. 2019 Jun;126:528-9. https://doi.org/10.1016/j.wneu.2019.03.160
  7. Kim SO, Jung SI, Won YS, Choi CS, Yang JY. A comparative study of local versus general anesthesia for chronic subdural hematoma in elderly patients over 60 years. Korean Journal of Neurotrauma. 2013;9(2):47-51. https://doi.org/10.13004/kjnt.2013.9.2.47
  8. Liu W, Bakker NA, Groen RJM. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014 Sep;121(3):665-73. https://doi.org/10.3171/2014.5.JNS132715
  9. Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo). 2001 Aug;41(8):371-81. https://doi.org/10.2176/nmc.41.371
  10. 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
  11. Tiwari A, Dmytriw AA, Bo R, Farkas N, Ye P, Gordon DS, et al. Recurrence and coniglobus volumetric resolution of subacute and chronic subdural hematoma post-middle meningeal artery embolization. Diagnostics (Basel). 2021 Feb;11(2):257.
  12. 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. https://doi.org/10.1227/01.NEU.0000335782.60059.17