Postsurgical Prophylactic Embolization of Chronic Subdural Hematomas in Patients with High Recurrence Risk: A Monocentric Study

Objectives: The gold standard treatment for chronic subdural hematomas (cSDHs) is the surgical evacuation through a burr hole. Recurrence after such surgical procedure may occur in 10%–20% of the cases. Embolization through the middle meningeal artery (MMA) is a promising technique for the treatment of cSDHs. The purpose of our study was to evaluate the feasibility, safety, and effectiveness, in terms of recurrence reduction, of postsurgical embolization of cSDH in patients with high risk of recurrence. Methods: A monocentric retrospective study was performed on prospectively collected data at Pitié-Salpêtrière Hospital. From March 2018 to February 2019, embolizations with calibrated microparticles through the MMA were performed in patients surgically treated for a cSDH with a high risk of recurrence, defined as follows: (1) previous recurrence of cSDH or (2) antiplatelet therapy or (3) full anticoagulation therapy or (4) coagulation disorder or (5) hepatopathy or (6) chronic ethylism. In all patients, a preembolization supra-aortic trunks (SATs) computed tomographic angiography was performed to rule out a dumb-bell thrombus on the aortic arch or severe atheroma/tortuosity of the SATs. Results: Forty-four patients met the inclusion criteria during the inclusion period. Two patients were excluded (one in a prolonged comatose state and another with a chronic renal failure). Two patients refused the embolization procedure. The last patient was excluded due to major atheroma on the SATs. Finally, 39 patients with 43 cSDHs (4 patients had bilateral SDHs) underwent the embolization procedure. Thirty-seven embolization procedures (95%) were performed under local anesthesia. Among the 43 cSDHs, 5 (9%) could not be embolized due to catheterization failure (4 cases) or to the presence of a “dangerous anastomosis” (1 case). No complication (either major or minor) was recorded. Only one recurrence (2.6%) requiring surgical retreatment was recorded during the follow-up period. Conclusion: Postsurgical embolization through the MMA is a simple and safe procedure, which may reduce the recurrence risk of cSDHs. These preliminary results should be confirmed by randomized controlled trials.

Publication History

Article published online:
26 April 2021