학술논문
Immediate procedural safety of adjunctive proximal coil occlusion in middle meningeal artery embolization for chronic subdural hematomas: Experience in 137 cases.
Document Type
Academic Journal
Author
Campos JK; Department of Neurological Surgery, University of California Irvine, Orange, CA, USA.; Meyer BM; College of Medicine, University of Arizona, Tucson, AZ, USA.; Zarrin DA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.; Khan MW; Carondelet Neurological Institute, St Joseph's Hospital, Tucson, AZ, USA.; Collard de Beaufort JC; College of Arts and Sciences, Syracuse University, Syracuse, NY, USA.; Amin G; Carondelet Neurological Institute, St Joseph's Hospital, Tucson, AZ, USA.; Avery MB; Department of Neurosurgery, Banner University Medical Center / The University of Arizona, Tucson, AZ, USA.; Golshani K; Department of Neurological Surgery, University of California Irvine, Orange, CA, USA.; Beaty NB; Department of Neurosurgery, Florida State University, Tallahassee Memorial Hospital, Tallahassee, FL, USA.; Bender MT; Department of Neurosurgery, University of Rochester, Rochester, NY, USA.; Colby GP; Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.; Lin LM; Carondelet Neurological Institute, St Joseph's Hospital, Tucson, AZ, USA.; Coon AL; Carondelet Neurological Institute, St Joseph's Hospital, Tucson, AZ, USA.
Source
Publisher: Sage Publications Country of Publication: United States NLM ID: 9602695 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2385-2011 (Electronic) Linking ISSN: 15910199 NLM ISO Abbreviation: Interv Neuroradiol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Endovascular embolization of the middle meningeal artery (MMA) has emerged as an adjunctive and stand-alone modality for the management of chronic subdural hematomas (cSDH). We report our experience utilizing proximal MMA coil embolization to augment cSDH devascularization in MMA embolization.
Methods: MMA embolization cases with adjunctive proximal MMA coiling were retrospectively identified from a prospectively maintained IRB-approved database of the senior authors.
Results: Of the 137 cases, all patients (n = 89, 100%) were symptomatic and underwent an MMA embolization procedure for cSDH. 50 of the patients underwent bilateral embolizations, with 53% (n = 72) for left-sided and 47% (n = 65) for right-sided cSDH. The anterior MMA branch was embolized in 19 (14%), posterior in 16 (12%), and both in 102 (74.5%) cases. Penetration of the liquid embolic to the contralateral MMA or into the falx was present in 38 (28%) and 31 (23%) cases, respectively, and 46 (34%) cases had ophthalmic or petrous collateral (n = 41, 30%) branches. MMA branches coiled include the primary trunk (25.5%, n = 35), primary and anterior or posterior MMA trunks (20%, n = 28), or primary with the anterior and posterior trunks (54%, n = 74). A mild ipsilateral facial nerve palsy was reported, which remained stable at discharge and follow-up. Absence of anterograde flow in the MMA occurred in 137 (100%) cases, and no cases required periprocedural rescue surgery for cSDH evacuation. The average follow-up length was 170 ± 17.9 days, cSDH was reduced by 4.24 ± 0.5(mm) and the midline shift by 1.46 ± 0.27(mm). Complete resolution was achieved in 63 (46.0%) cases.
Conclusion: Proximal MMA coil embolization is a safe technique for providing additional embolization/occlusion of the MMA in cSDH embolization procedures. Further studies are needed to evaluate the potential added efficacy of this technique.
Competing Interests: Declaration of conflicting interestsAlexander L. Coon, M.D. is a consultant for Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular, Cerenovus, Rapid Medical, Avail MedSystems, Imperative Care, Deinde, InNeuroCo, Q'apel; a proctor for MicroVention-Termo, Stryker Neurovascular, and Medtronic Neurovascular. Li-Mei Lin, M.D. is a proctor for Medtronic Neurovascular, Stryker Neurovascular, MicroVention-Terumo; and a consultant for Medtronic Neurovascular, Stryker Neurovascular, MicroVention-Terumo, Rapid Medical, and Balt. Geoffrey P. Colby, M.D., PhD is a consultant for Medtronic Neurovascular, MicroVention-Terumo, Rapid Medical, Cerenovus, and Stryker Neurovascular. Matthew Bender, M.D. is a proctor Stryker Neurovascular. Narlin B. Beaty, M.D. is a proctor for Medtronic Neurovascular, Stryker Neurovascular, and CMO of NeuroMedica. All other authors have no conflict of interest. No author received financial support in conjunction with the generation of this submission.
Methods: MMA embolization cases with adjunctive proximal MMA coiling were retrospectively identified from a prospectively maintained IRB-approved database of the senior authors.
Results: Of the 137 cases, all patients (n = 89, 100%) were symptomatic and underwent an MMA embolization procedure for cSDH. 50 of the patients underwent bilateral embolizations, with 53% (n = 72) for left-sided and 47% (n = 65) for right-sided cSDH. The anterior MMA branch was embolized in 19 (14%), posterior in 16 (12%), and both in 102 (74.5%) cases. Penetration of the liquid embolic to the contralateral MMA or into the falx was present in 38 (28%) and 31 (23%) cases, respectively, and 46 (34%) cases had ophthalmic or petrous collateral (n = 41, 30%) branches. MMA branches coiled include the primary trunk (25.5%, n = 35), primary and anterior or posterior MMA trunks (20%, n = 28), or primary with the anterior and posterior trunks (54%, n = 74). A mild ipsilateral facial nerve palsy was reported, which remained stable at discharge and follow-up. Absence of anterograde flow in the MMA occurred in 137 (100%) cases, and no cases required periprocedural rescue surgery for cSDH evacuation. The average follow-up length was 170 ± 17.9 days, cSDH was reduced by 4.24 ± 0.5(mm) and the midline shift by 1.46 ± 0.27(mm). Complete resolution was achieved in 63 (46.0%) cases.
Conclusion: Proximal MMA coil embolization is a safe technique for providing additional embolization/occlusion of the MMA in cSDH embolization procedures. Further studies are needed to evaluate the potential added efficacy of this technique.
Competing Interests: Declaration of conflicting interestsAlexander L. Coon, M.D. is a consultant for Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular, Cerenovus, Rapid Medical, Avail MedSystems, Imperative Care, Deinde, InNeuroCo, Q'apel; a proctor for MicroVention-Termo, Stryker Neurovascular, and Medtronic Neurovascular. Li-Mei Lin, M.D. is a proctor for Medtronic Neurovascular, Stryker Neurovascular, MicroVention-Terumo; and a consultant for Medtronic Neurovascular, Stryker Neurovascular, MicroVention-Terumo, Rapid Medical, and Balt. Geoffrey P. Colby, M.D., PhD is a consultant for Medtronic Neurovascular, MicroVention-Terumo, Rapid Medical, Cerenovus, and Stryker Neurovascular. Matthew Bender, M.D. is a proctor Stryker Neurovascular. Narlin B. Beaty, M.D. is a proctor for Medtronic Neurovascular, Stryker Neurovascular, and CMO of NeuroMedica. All other authors have no conflict of interest. No author received financial support in conjunction with the generation of this submission.