Short-term follow-up pilot study of sole middle meningeal artery embolization for chronic subdural hematoma: influence of internal architecture on the radiological outcomes

Purpose: To identify prognostic factors with emphasis on chronic subdural hematoma (CSDH) architecture that determines short-term outcome of middle meningeal artery embolization (MMAE).

Methods: Consecutive CSDH patients treated by MMAE (November 2019 and March 2022) were retrospectively analyzed. Four architectures were analyzed: homogeneous, laminar, separated, and trabecular types. Predictor variables from baseline CT were correlated with radiological endpoint (≥ 50% of hematoma volume reduction), time to reach the endpoint, and rate of volume reduction.

Results: Study included 50 patients with 56 CSDHs (median age [first quartile, Q1; third quartile, Q3] 70.5 [60, 78.3] years; 36 were men). Separated type reached the endpoint at a lower rate on both bivariate (p = 0.02) and multivariate Cox model (0.034). Kaplan-Meier curves demonstrated that the median [Q1, Q3] time for 50% of the hematomas to reach the endpoint was 5 [4, 8], 4 [3, 5], 15 [15, 15], and 11 [4, 19] weeks for homogeneous, laminar, separated, and trabecular types, respectively. Linear mixed-effect model demonstrated a significant variation in the slope of hematoma volume reduction that was - 4.16 (95% confidence interval [CI] - 5.4, - 2.9), - 6.7 (95% CI - 8.35, - 5.1), - 2.03 (95% CI - 4.14, 0.08), and - 5.06 (95% CI - 6.8, - 3.32) ml per week for homogeneous, laminar, separated, and trabecular subtypes, respectively.

Conclusion: Separated CSDH is a poor prognostic type in achieving radiological endpoint and a slower rate of volume reduction. While, homogeneous and laminar types reached the endpoint faster than separated and trabecular types on short-term follow-up.

 

Comments:

Summary of findings: The study analyzed 50 patients with 56 chronic subdural hematomas (CSDH) who were treated with middle meningeal artery embolization (MMAE) between November 2019 and March 2022.

Four CSDH architecture types were examined: homogeneous, laminar, separated, and trabecular.

The separated type of CSDH achieved the radiological endpoint (≥ 50% reduction in hematoma volume) at a lower rate compared to the other types, as indicated by both bivariate and multivariate Cox models.

Kaplan-Meier curves showed that the median time for 50% of the hematomas to reach the endpoint was 5 weeks for homogeneous, 4 weeks for laminar, 15 weeks for separated, and 11 weeks for trabecular types.

A linear mixed-effect model demonstrated variations in the rate of hematoma volume reduction. The rates per week were approximately -4.16 ml for homogeneous, -6.7 ml for laminar, -2.03 ml for separated, and -5.06 ml for trabecular subtypes.
 

Conclusion: The separated CSDH architecture is associated with a poorer prognosis in achieving the radiological endpoint and a slower rate of volume reduction.

Homogeneous and laminar types tend to reach the endpoint faster compared to separated and trabecular types in short-term follow-up.

It's important to note that these findings are based on a retrospective analysis of patients treated with MMAE and may have limitations. Further research and validation are necessary to confirm these results.

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