Multidisciplinary consensus-based statement on the current role of middle meningeal artery embolization (MMAE) in chronic SubDural hematoma (cSDH)

J Bartek; A Biondi; V Bonhomme; L Castellan; G Catapano; M Cenzato; G Di Nuzzo; E De Robertis; F Giordano; C Iaccarino; Z Kulcsar; M A Möhlenbruch; A Raabe; F Rickard; C S Romero; T Schubert; Shipway D; C Sicignano; M Muto

doi:10.1016/j.bas.2024.104143

Multidisciplinary consensus-based statement on the current role of middle meningeal artery embolization (MMAE) in chronic SubDural hematoma (cSDH)

Brain Spine. 2024 Nov 19:4:104143. doi: 10.1016/j.bas.2024.104143. eCollection 2024.

Authors

J Bartek¹, A Biondi^{2

3}, V Bonhomme^{4

5}, L Castellan⁶, G Catapano⁷, M Cenzato⁸, G Di Nuzzo⁷, E De Robertis⁹, F Giordano¹⁰, C Iaccarino^{11

12

13}, Z Kulcsar¹⁴, M A Möhlenbruch¹⁵, A Raabe¹⁶, F Rickard¹⁷, C S Romero¹⁸, T Schubert¹⁴, Shipway D^{19

20

21}, C Sicignano²², M Muto¹⁰

Affiliations

¹ EANS Delegate, Dep. of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
² WFITN Delegate, Department of Interventional Neuroradiology, Besançon University Hospital, F-25000, Besançon, France.
³ Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université Bourgogne Franche-Comté, F-25000, Besançon, France.
⁴ ESAIC Delegate, Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium.
⁵ Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, GIGA-Research, Liege University, Liege, Belgium.
⁶ AINR Delegate, Neuroradiology Department, San Martino Hospital, Genoa, Italy.
⁷ SINCh Delegate, Neurosurgery Unit, Ospedale Del Mare, Naples, Italy.
⁸ EANS Delegate, Dept. of Neurosurgery, Niguarda Hospital, Milan, Italy.
⁹ ESAIC Delegate, Section of Anaesthesia, Analgesia and Intensive Care, Department of Medicine and Surgery, University of Perugia, Italy.
¹⁰ ESNR Delegate, Diagnostic and Interventional Neuroradiology, Cardarelli Hospital, Naples, Italy.
¹¹ NTC-WFNS Delegate, Advisory Group of the Neurotraumatology Committee of the WFNS, Neurosurgery, School of Neurosurgery, University of Modena and Reggio Emilia, Italy.
¹² Neurosurgery Division, University Hospital of Modena, Modena, Italy.
¹³ Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy.
¹⁴ ESMINT Delegate, Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland.
¹⁵ ESNR Delegate, Neuroradiology, Heidelberg University Hospital, Heidelberg Germany.
¹⁶ EANS Delegate, Department of Neurosurgery, Inselspital Bern, Bern, Switzerland.
¹⁷ EuGMS Delegate, Consultant Geriatrician and Perioperative Physician, North Bristol NHS Trust, Bristol, UK.
¹⁸ ESAIC Delegate, Department of Anaesthesia and Intensive Care Medicine, University General Hospital, European University of Valencia, Spain.
¹⁹ EuGMS Delegate, Consultant Physician & Perioperative Geriatrician, North Bristol NHS Trust, Bristol, UK.
²⁰ Chair, British Geriatric Society Perioperative Medicine Group, UK.
²¹ Honorary Senior Clinical Lecturer, University of Bristol, UK.
²² AINR Delegate, Neuroradiology, Ospedale Del Mare, Naples, Italy.

Abstract

Introduction: Middle Meningeal Artery Embolization (MMAE) in patients with chronic SubDural Hematoma (cSDH) is a novel treatment approach, albeit the specific role of MMAE in the treatment of cSDH is not yet defined.

Research question: The aim of this work is to provide a consensus-based statement from a multidisciplinary panel on the current role of MMAE in patients with cSDH.

Materials and methods: A literature search was performed using the keywords MMAE and cSDH. Based on the available published data, the panel was asked if a consensus could be reached on the role of MMAE in both de novo as well as in recurrent cSDH.

Results: The panel reached a consensus on the current role of MMAE in both de novo- and recurrent cSDH, as well as in patients on antithrombotics and those with coagulopathy. MMAE should be considered in the following scenarios:1)As "stand-alone" treatment in de novo cSDH requiring intervention but where surgery is prevented due to either coagulopathy or in patients on antithrombotics in whom the risk of suspension is considered unacceptably high,2)as "stand-alone" treatment in recurrent cSDH requiring intervention but where surgery is prevented due to either coagulopathy or in those on antithrombotics in whom the risk of suspension is considered unacceptably high and3)as "adjunct to surgery" in all recurrent cSDH.

Discussion and conclusion: This statement is to be considered an expert consensus opinion of delegates representing key international medical societies of specialists involved in the care of cSDH patients.

Keywords: Anaesthesia; Chronic subdural hematoma; Endovascular; Geriatrics; Middle meningeal artery embolization; Neurosurgery.