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Journal of Neurosurgical Sciences 2021 Jun 10

DOI: 10.23736/S0390-5616.21.05335-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Awake transradial middle meningeal artery embolization and twist drill craniostomy for chronic subdural hematomas in the elderly: case series and technical note

Ehsan DOWLATI 1 , Kelsi CHESNEY 1, Austin B. CARPENTER 2, Mitchell ROCK 2, Nirali PATEL 1, Jeffrey C. MAI 1, 3, Ai-Hsi LIU 4, Rocco A. ARMONDA 1, 3, Daniel R. FELBAUM 1, 3

1 Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA; 2 Georgetown University School of Medicine, Washington, DC, USA; 3 Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA; 4 Department of Radiology, MedStar Washington Hospital Center, Washington, DC, USA


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KEY WORDS: BACKGROUND: Due to prohibitive perioperative risk factors, optimal treatment for chronic subdural hematomas (cSDH) in the elderly remains unclear. Minimally invasive techniques are a viable option and include bedside subdural evacuation port system (SEPS), as well as prevention of recurrence with middle meningeal artery (MMA) embolization. We present a case series of elderly patients undergoing combined transradial MMA embolization and bed-side craniostomy as primary treatment for cSDH.
METHODS: Patients 70 years and older from 2019 to 2020 that underwent single setting, awake transradial MMA embolization with concurrent SEPS placement under local anesthesia were included. Those with prior treatments, interventions performed under general anesthesia, or with less than 60-day follow-up were excluded. Descriptive analyses of baseline characteristics,
radiologic parameters, comorbidities, and outcome measures were completed.
RESULTS: 20 elderly patients (mean age of 81.0 years) with multiple comorbidities underwent 28 MMA embolization+SEPS procedures as primary treatment for cSDH. Mean cSDH thickness was 1.8cm±0.6 cm with 7.3±3.9 mm midline shift. All patients tolerated the procedure well. 1/20 (5.0%) patients died within 30 days of the procedure. A majority of patients were discharged to home (12/20; 60.0%). There was an average of 3.6-month follow-up and one patient (5.0%) developed recurrence in the follow-up period requiring further intervention.
CONCLUSIONS: In select elderly patients with high perioperative risk factors, primary treatment of cSDH using awake transradial MMA embolization+SEPS placement is a minimally invasive, feasible, and safe option. Further comparative studies are warranted to evaluate efficacy of the treatment.

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