Endovascular treatment of chronic subdural hematoma in a dual-trained neurosurgical unit: Results and proposal of a randomized controlled trial protocol

Neurocirugia (Astur : Engl Ed). 2025 Jan-Feb;36(1):28-38. doi: 10.1016/j.neucie.2024.09.002. Epub 2024 Sep 17.

Abstract

Introduction: Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition with an increasing incidence due to the rising life expectancy and the widespread use of anticoagulant and antiplatelet therapies. Insights into the inflammatory origins of cSDH led to the exploration of Middle Meningeal Artery (MMA) embolization as a therapeutic strategy. In recent years the endovascular treatment of MMA has gained momentum. Herein we present the initial experience of a dual trained neurovascular unit implementing this therapeutic technique.

Methods: This single-center, prospective pilot study aimed to evaluate the feasibility, safety, and efficacy of MMA embolization in the treatment of cSDH. Following ethical approval and informed consent, demographic, clinical, and radiological data were collected. Patients requiring emergent surgical treatment were excluded. The study focused on assessing clinical outcomes, including the Modified Rankin Score (mRS) and volumetric analysis of cSDH, before and after embolization.

Results: Fifteen patients underwent MMA embolization, with a predominance of males (80%) and a mean age of 72.4 years. The most common presenting symptom was headache (53.3%). The average hospital stay was 3.9 days. Various embolization techniques were employed, with DMSO-EVOH being the most frequent. All procedures were successfully conducted without complications. Although not statistically significant, trends suggested better outcomes in patients with homogeneous cSDH on the CT scan, displaying the cotton wool sign on angiography and treated with EVOH-DMSO.

Conclusion: MMA embolization for cSDH demonstrates promise as a safe and effective treatment, potentially reducing the need for surgical intervention and recurrence rates. This study lays the groundwork for a larger, randomized controlled trial which protocol is herein presented.

Keywords: Análisis volumétrico; Arteria meníngea media; Chronic subdural hematoma; Embolización; Embolization; Ensayo clínico randomizado; Hematoma subdural crónico; Middle Meningeal Artery; Neurocirugía; Neurosurgery; Randomized controlled trial; Volumetric analysis.

Publication types

  • Clinical Trial Protocol

MeSH terms

  • Aged
  • Aged, 80 and over
  • Embolization, Therapeutic*
  • Endovascular Procedures* / methods
  • Feasibility Studies
  • Female
  • Hematoma, Subdural, Chronic* / diagnostic imaging
  • Hematoma, Subdural, Chronic* / surgery
  • Hematoma, Subdural, Chronic* / therapy
  • Humans
  • Male
  • Meningeal Arteries / diagnostic imaging
  • Meningeal Arteries / surgery
  • Middle Aged
  • Neurosurgery
  • Pilot Projects
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Treatment Outcome