Article Text

Download PDFPDF

O-028 Post-surgical prophylactic embolization of chronic sub-dural hematomas in patients with high recurrence risk: a monocentric study
  1. E Shotar1,
  2. B Mathon1,
  3. S Lenck1,
  4. L Meyblum1,
  5. V Degos2,
  6. K Premat1,
  7. N Sourour1,
  8. A Boch3,
  9. A Carpentier3,
  10. F Clarençon1
  1. 1Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
  2. 2Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
  3. 3Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France


Background and purpose 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 to 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 post-surgical embolization of cSDH in patients with a high risk of recurrence.

Materials and methods Monocentric retrospective study performed on prospectively collected data at the 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) hepathopathy or 6) chronic ethylism. In all patients, a pre-embolization supra-aortic trunks (SATs) CT-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. A 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 a surgical retreatment was recorded during the follow-up period.

Conclusion Post-surgical 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.

Disclosures E. Shotar: None. B. Mathon: None. S. Lenck: None. L. Meyblum: None. V. Degos: None. K. Premat: None. N. Sourour: 2; C; Medtronic. A. Boch: None. A. Carpentier: None. F. Clarençon: 2; C; Balt, Artedrone, Penumbra.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.