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

  • Interventional Neuroradiology
  • Published:
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Abstract

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.

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Data Availability

The data that support the findings of this study are available from the corresponding author, [UB], upon reasonable request.

Abbreviations

CSDH:

Chronic subdural hematoma

MMAE:

Middle meningeal artery embolization

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Authors and Affiliations

  1. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22S Greene Street, Baltimore, MD, 21201, USA

    Bodanapally K. Uttam, Fleiter R. Thorsten, Colasurdo Marco & Gandhi Dheeraj

  2. Division of Biostatistics and Bioinformatics109B, University of Maryland School of Medicine, 660 W. Redwood Street, MD, 21201, Howard Hall Baltimore, USA

    Liang Yuanyuan

  3. Department of Neurosurgery, University of Maryland School of Medicine, 22 S Greene Street, Suite S-12-D, Baltimore, MD, 21201, USA

    Aarabi Bizhan

  4. Department of Neurology, University of Maryland School of Medicine, 22S Greene Street, Baltimore, MD, 21201, USA

    Khalid Mazhar

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Uttam, B.K., Yuanyuan, L., Bizhan, A. et al. Short-term follow-up pilot study of sole middle meningeal artery embolization for chronic subdural hematoma: influence of internal architecture on the radiological outcomes. Neuroradiology 65, 1143–1153 (2023). https://doi.org/10.1007/s00234-023-03158-1

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