3- jährige monozentrische Erfahrung in der interventionellen Behandlung des chronischen Subduralhämatoms.

The chronic subdural hematoma is a common entity in the daily neurosurgical practice with increasing prevalence due to the aging population and antithrombotic therapy. It appears after bleeding in the so-called subdural space. Surgical evacuation of big/symptomatic hematomas is the treatment of choice. The embolization of the Art. meningea media has become an interesting target as an alternative option to conventional surgery. Mandai (2000) reported a case of a patient with coagulopathy with recurrent chronic subdural hematoma after many prior surgeries that remitted after embolization of the AMM. Since then, many people have seen this new modality as an alternative or a complementary method to conventional surgical treatment. Opposed to the conventional surgical treatment this method is less invasive and addresses the pathophysiology of this disease. Our research aimed to primarily identify the failure rate as well as to contribute to clarifying the indication of this novel method. We analyzed retrospectively our results and then compared them with our surgically treated patients, as well as with the literature.

We retrospectively reviewed 130 embolization procedures without preceding surgery conducted internally (2020-2023). Embolization of the AMM was performed on a bi-plane angiography suite Siemens artis zee under general anesthesia by experienced neurosurgeons using Contour TM 150-250 µm polyvinyl alcohol (PVA) particles delivered via 4F guiding catheter and Progreat TM microcatheter. We analyzed the treatment failure rate (as a need for secondary treatment of the hematoma) and complications.

101 pat., 29 bilateral (=130 procedures) (follow-up 89 pat.), 13 surgeries due to neurological deterioration (<1week), 6 surgeries due to recurrence or persistent hematoma, 5 complications: 1 unilat. amaurosis (partially transient), 2 facial paresis (transient), 1 stroke, 2 deaths (unrelated to the procedure); 23.1% recurrence after primary surgery without prior embolization (2020/21 = 2 years).

We found a failure rate of AMM embolization of 14.6% (lit. 1.4%-8.9%). 13 hematomas with mass signs showed treatment failure due to early neurological worsening. As our previous study showed, hematomas with a maximal width < 18 mm and midline shift < 5 mm measured on admission CT scan in the frontal plane without hyperdense hematoma could be candidates for endovascular treatment with MMA embolization. The complication rate is low ~5%.