Abstract Number ‐ 97: Middle meningeal artery embolization to treat chronic subdural hematomas – Retrospective study of morphological parameters

Abstract

Introduction Chronic subdural hematomas are a common neurovascular condition that involve the gradual and continual exudation of fluid from a compromised cell layer lining the dura [1]. Embolization of the middle meningeal artery (MMAE) results in lower recurrence rates as compared to traditional surgical burr hole evacuation [2‐4]. Liquid embolic agents such as cyanoacrylates or ethylene vinyl alcohol copolymers can potentially provide a distinct advantage with greater distal penetration resulting in faster hematoma resolution [5]. Their inherent radiopacity (after pre‐mixing) also allows for accurate visualization and control over embolization. The hypothesis of this study is that liquid embolic surface area would correlate with more effective cSDH volume resolution in patients. Methods Under IRB approval, we retrospectively analyzed non‐contrast head CTs and immediate post‐embolization flat‐detector CTs from 45 patients who underwent first‐line MMAE with a liquid embolic. Patients who received any neurosurgical intervention were excluded. 3D‐Slicer was used to segment and calculate hematoma volumes pre‐embolization, as well as at 1‐month, 3‐months, and 6‐months post‐embolization. The flat‐detector CT scans were also segmented to calculate the surface area of the liquid embolic. Results There was significant reduction in hematoma volume at 1‐, 3‐ and 6‐months with respect to the preoperative cSDH volume (Figure A, Pre: pre‐treatment, mo: month). The liquid embolic surface area significantly correlated with (a) pre‐embolization hematoma volume (R2 = 0.27, p = 0.0002, n = 45), (b) the reduction in volume at 1‐month post‐embolization (R2 = 0.16, p = 0.007, n = 41), (c) volume reduction at 3‐months post‐embolization (R2 = 0.29, p = 0.0015, n = 32), (d) hematoma volume resorption rate (cc/day) calculated at 1‐month post‐embolization (R2 = 0.16, p = 0.011, n = 39), and (e) hematoma volume resorption rate calculated at 3‐months post‐embolization (R2 = 0.34, p = 0.0003, n = 34, Figure B). The liquid embolic surface area was not correlated to the volume reduction at 6‐months (p = 0.3, n = 26). Conclusions The luminal surface area of MMA vasculature embolized with liquid embolics may be correlated to the reduction in cSDH volumes. The liquid embolic segmentation method used here needs further refinement to improve accuracy. Additional data sets are required to confirm the correlations reported here.