Rescue management of recurrent or growing non-acute subdural hematoma following standalone or adjunctive middle meningeal artery embolization: A case series and systematic review
Abstract
ObjectiveRecurrent or growing non-acute subdural hematoma (SDH) following standalone or adjunctive middle meningeal artery embolization (MMAe) present a complex clinical challenge. This study aims to investigate the multifactorial causes of recurrence and growing SDH, including vascular and systemic contributors, and explores management strategies to improve outcomes.MethodsWe conducted a retrospective analysis of 22 patients with non-acute SDH requiring rescue treatment after adjunctive or stand-alone MMAe. Patients with documented trauma deemed responsible for the SDH expansion were excluded. Data were collected on patient demographics, clinical presentations, imaging findings, treatment approaches, and outcomes. A systematic review was also conducted across PubMed, Web of Science, Scopus, and Embase databases, adhering to PRISMA guidelines.ResultsNon-traumatic recurrent or growing SDHs were associated with MMA recanalization (27%), contralateral supply from the contralateral MMA (27%), CSF-venous fistulas (5%), and recruitments of vascular collaterals such as deep temporal artery (5%). Management strategies included, respectively, repeat MMAe using polyvinyl alcohol particles, coils, and liquid agents; contralateral MMAe, transvenous embolization for CSF-venous fistulas; and targeted embolization for other vascular contributors. Follow-up assessments were available for 14 patients (64%). Of these, 10 patients (45%) achieved complete resolution of symptoms, three patients…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 22 participants or records.
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