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Long-Term Middle Meningeal Artery Caliber Reduction Following Trisacryl Gelatine Microsphere Embolization for the Treatment of Chronic Subdural Hematoma

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Abstract

Purpose

Middle meningeal artery (MMA) particle embolization is a promising treatment of chronic subdural hematomas (CSDH). The main purpose of this study is to measure MMA proximal caliber and assess the visibility of the two main MMA branches as a surrogate for long-term distal arterial patency following MMA CSDH embolization with trisacryl gelatine microspheres (TAGM).

Methods

This is a single-center retrospective study. All patients having undergone MMA TAGM only embolization for CSDH treatment between 15 March 2018 and 6 June 2020 with an interpretable follow-up magnetic resonance imaging (MRI) examination and no confounding factors were included. Patients were compared with controls matched for age, sex and MRI machine. Two independent readers analyzed the MRI images.

Results

In this study, 30 patients having undergone embolization procedures using TAGM of 36 MMAs were included. The follow-up MRI scans were performed after a mean delay of 14.8 ± 7.1 months (range 4.9–29.4 months). The mean diameter of TAGM embolized MMAs (1 mm; 95% confidence interval, CI 0.9–1.1) was significantly smaller than the mean diameter of paired control MMAs (1.3 mm; 95% CI 1.3–1.4) (p < 0.001). The mean proximal diameter of the embolized MMAs (0.9 mm; 95% CI 0.7–1.1) was significantly smaller than the mean diameter of the contralateral MMAs in the same patients (1.4 mm; 95% CI 1.3–1.6)(p < 0.001).

Conclusion

Long-term follow-up MRI demonstrated a significant impact of TAGM embolization on MMA proximal caliber as well as on the visibility of the two main MMA branches. All comparisons indicated that there was a probable lasting impact of embolization on the patency of distal branches.

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References

  1. Ban SP, Hwang G, Byoun HS, Kim T, Lee SU, Bang JS, Han JH, Kim CY, Kwon OK, Oh CW. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma. Radiology. 2018;286:992-9. https://doi.org/10.1148/radiol.2017170053.

    Article  PubMed  Google Scholar 

  2. Link TW, Boddu S, Paine SM, Kamel H, Knopman J. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Series of 60 Cases. Neurosurgery. 2019;85:801-7. https://doi.org/10.1093/neuros/nyy521.

    Article  PubMed  Google Scholar 

  3. Ng S, Derraz I, Boetto J, Dargazanli C, Poulen G, Gascou G, Lefevre PH, Molinari N, Lonjon N, Costalat V. Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: a pilot study assessing hematoma volume resorption. J Neurointerv Surg. 2020;12:695-9. https://doi.org/10.1136/neurintsurg-2019-015421.

    Article  PubMed  Google Scholar 

  4. Shotar E, Meyblum L, Premat K, Lenck S, Degos V, Grand T, Cortese J, Pouvelle A, Pouliquen G, Mouyal S, Boch AL, Carpentier A, Sourour NA, Mathon B, Clarençon F. Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma. J Neurointerv Surg. 2020;12:1209-13. https://doi.org/10.1136/neurintsurg-2020-016048.

    Article  PubMed  Google Scholar 

  5. Kang J, Whang K, Hong SK, Pyen JS, Cho SM, Kim JY, Kim SH, Oh JW. Middle Meningeal Artery Embolization in Recurrent Chronic Subdural Hematoma Combined with Arachnoid Cyst. Korean J Neurotrauma. 2015;11:187-90.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Matsumoto H, Hanayama H, Okada T, Sakurai Y, Minami H, Masuda A, Tominaga S, Miyaji K, Yamaura I, Yoshida Y. Which surgical procedure is effective for refractory chronic subdural hematoma? Analysis of our surgical procedures and literature review. J Clin Neurosci. 2018;49:40-7.

    Article  PubMed  Google Scholar 

  7. Catapano JS, Ducruet AF, Nguyen CL, Baranoski JF, Cole TS, Majmundar N, Wilkinson DA, Fredrickson VL, Cavalcanti DD, Albuquerque FC. Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis. J Neurointerv Surg. 2021;13:657-60. https://doi.org/10.1136/neurintsurg-2020-016552.

    Article  PubMed  Google Scholar 

  8. Fiorella D, Arthur AS. Middle meningeal artery embolization for the management of chronic subdural hematoma. J Neurointerv Surg. 2019;11:912-5.

    Article  PubMed  Google Scholar 

  9. Shotar E, Premat K, Barberis E, Talbi A, Lenck S, Cohen C, Degos V, Sourour NA, Mathon B, Clarençon F. Dural arteriovenous fistula formation following bilateral middle meningeal artery embolization for the treatment of a chronic subdural hematoma: a case report. Acta Neurochir (Wien). 2021;163:1069-73. https://doi.org/10.1007/s00701-020-04696-w.

    Article  PubMed  Google Scholar 

  10. Pouvelle A, Pouliquen G, Premat K, Chougar L, Lenck S, Degos V, Sourour NA, Mathon B, Clarençon F, Shotar E. Larger Middle Meningeal Arteries on Computed Tomography Angiography in Patients with Chronic Subdural Hematomas as Compared with Matched Controls. J Neurotrauma. 2020;37:2703-8. https://doi.org/10.1089/neu.2020.7168.

    Article  PubMed  Google Scholar 

  11. Wang CY, Hu J, Sheth RA, Oklu R. Emerging Embolic Agents in Endovascular Embolization: An Overview. Prog Biomed Eng (Bristol). 2020;2:012003.

    Article  PubMed  Google Scholar 

  12. Carli DF, Sluzewski M, Beute GN, van Rooij WJ. Complications of particle embolization of meningiomas: frequency, risk factors, and outcome. AJNR Am J Neuroradiol. 2010;31:152-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Duvnjak S, Ravn P, Green A, Andersen PE. Clinical long-term outcome and reinterventional rate after uterine fibroid embolization with nonspherical versus spherical polyvinyl alcohol particles. Cardiovasc Intervent Radiol. 2016;39:204-9.

    Article  PubMed  Google Scholar 

  14. Lewis AL, Adams C, Busby W, Jones SA, Wolfenden LC, Leppard SW, Palmer RR, Small S. Comparative in vitro evaluation of microspherical embolisation agents. J Mater Sci Mater Med. 2006;17:1193-204.

    Article  CAS  PubMed  Google Scholar 

  15. Sun X, Dai H, Guo P, Sha X. Biocompatibility of a new kind of polyvinyl alcohol embolic microspheres: in vitro and in vivo evaluation. Mol Biotechnol. 2019;61:610-21.

    Article  CAS  PubMed  Google Scholar 

  16. Hu J, Albadawi H, Chong BW, Deipolyi AR, Sheth RA, Khademhosseini A, Oklu R. Advances in biomaterials and technologies for vascular embolization. Adv Mater. 2019;31:e1901071.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Torres D, Costa NV, Pisco J, Pinheiro LC, Oliveira AG, Bilhim T. Prostatic artery embolization for benign prostatic hyperplasia: prospective randomized trial of 100-300 μm versus 300-500 μm versus 100- to 300-μm + 300- to 500-μm embospheres. J Vasc Interv Radiol. 2019;30:638-44.

    Article  PubMed  Google Scholar 

  18. Pelage JP, Le Dref O, Beregi JP, Nonent M, Robert Y, Cosson M, Jacob D, Truc JB, Laurent A, Rymer R. Limited uterine artery embolization with tris-acryl gelatin microspheres for uterine fibroids. J Vasc Interv Radiol. 2003;14:15-20.

    Article  PubMed  Google Scholar 

  19. Han K, Kim SY, Kim HJ, Kwon JH, Kim GM, Lee J, Won JY, Shin HJ, Yoon EJ, Kim MD. Nonspherical Polyvinyl Alcohol Particles versus Tris-Acryl Microspheres: Randomized Controlled Trial Comparing Pain after Uterine Artery Embolization for Symptomatic Fibroids. Radiology. 2021;298:458-65.

    Article  PubMed  Google Scholar 

  20. Sutter O, Soyer P, Shotar E, Dautry R, Guerrache Y, Placé V, Opréa R, Ricbourg A, Le Dref O, Boudiaf M, Sirol M, Dohan A. Diffusion-weighted MR imaging of uterine leiomyomas following uterine artery embolization. Eur Radiol. 2016;26:3558-70.

    Article  PubMed  Google Scholar 

  21. Bendszus M, Klein R, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L. Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of meningiomas. AJNR Am J Neuroradiol. 2000;21:255-61.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Tomashefski JF Jr, Cohen AM, Doershuk CF. Longterm histopathologic follow-up of bronchial arteries after therapeutic embolization with polyvinyl alcohol (Ivalon) in patients with cystic fibrosis. Hum Pathol. 1988;19:555-61.

    Article  PubMed  Google Scholar 

  23. Davidson GS, Terbrugge KG. Histologic long-term follow-up after embolization with polyvinyl alcohol particles. AJNR Am J Neuroradiol. 1995;16(4 Suppl):843-6.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Laurent A, Wassef M, Namur J, Martal J, Labarre D, Pelage JP. Recanalization and particle exclusion after embolization of uterine arteries in sheep: a long-term study. Fertil Steril. 2009;91:884-92.

    Article  PubMed  Google Scholar 

  25. Lee KS, Bae WK, Doh JW, Bae HG, Yun IG. Origin of chronic subdural haematoma and relation to traumatic subdural lesions. Brain Inj. 1998;12:901-10.

    Article  CAS  PubMed  Google Scholar 

  26. Markwalder TM, Reulen HJ. Influence of neomembranous organisation, cortical expansion and subdural pressure on the post-operative course of chronic subdural haematoma—an analysis of 201 cases. Acta Neurochir (Wien). 1986;79:100-6.

    Article  CAS  PubMed  Google Scholar 

  27. Ishibashi A, Yokokura Y, Miyagi J. Clinical analysis of nineteen patients with traumatic subdural hygromas. Kurume Med J. 1994;41:81-5.

    Article  CAS  PubMed  Google Scholar 

  28. Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation. 2017;14:108.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tanaka T, Fujimoto S, Saito K, Kaimori M. [Histological study of operated cases of chronic subdural hematoma in adults: relationship between dura mater and outer membrane]. No Shinkei Geka. 1997;25:701-5.

    CAS  PubMed  Google Scholar 

  30. Takizawa K, Sorimachi T, Ishizaka H, Osada T, Srivatanakul K, Momose H, Matsumae M. Enlargement of the middle meningeal artery on MR angiography in chronic subdural hematoma. J Neurosurg. 2016;124:1679-83.

    Article  PubMed  Google Scholar 

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Acknowledgements

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l’Hôpital, 75013, Paris, France

    Eimad Shotar, Eric Barberis, Lydia Chougar, Sacha Bensoussan, Damien Parat, Haroun Ghannouchi, Kevin Premat, Stephanie Lenck, Stéphane Lehericy, Nader-Antoine Sourour & Frédéric Clarençon

  2. Sorbonne Université, Paris, France

    Lydia Chougar, Vincent Degos, Stéphane Lehericy, Bertrand Mathon & Frédéric Clarençon

  3. Department of Neurosurgical Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France

    Vincent Degos

  4. Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France

    Bertrand Mathon

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  1. Eimad Shotar
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  2. Eric Barberis
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  3. Lydia Chougar
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  13. Frédéric Clarençon
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Contributions

All authors contributed to the study contribution and design. Material preparation, data collection and analysis were performed by Eimad Shotar and Eric Barberis. The first draft of the manuscript was written by Eimad Shotar and all authors commented on the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Eimad Shotar.

Ethics declarations

Conflict of interest

The authors of this manuscript declare relationships with the following companies: F. Clarençon reports conflict of interest (unrelated) with Medtronic, Guerbet, Balt Extrusion (payment for readings), Codman Neurovascular (core laboratory). N.-A. Sourour is consultant for Medtronic, Balt Extrusion, Microvention. E. Shotar is principal investigator of a randomized controlled trial related to CSDH embolization financed by a PHRC-IR public grant (unrelated to the present study). E. Barberis, L. Chougar, S. Bensoussan, D. Parat, H. Ghannouchi, K. Premat, S. Lenck, V. Degos, S. Lehericy and B. Mathon declare that they have no competing interests.

Ethical standards

The institutional review board approved this study (CERIM IRB CRM-2003-063). The need for signed patient consent was waived.

Additional information

The authors Eimad Shota and Eric Barberis contributed equally to the manuscript.

Data availability

Raw data are available upon reasonable request from the corresponding author.

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Shotar, E., Barberis, E., Chougar, L. et al. Long-Term Middle Meningeal Artery Caliber Reduction Following Trisacryl Gelatine Microsphere Embolization for the Treatment of Chronic Subdural Hematoma. Clin Neuroradiol 33, 113–120 (2023). https://doi.org/10.1007/s00062-022-01189-4

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