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Efficacy and mid-term outcome of middle meningeal artery embolization with or without burr hole evacuation for chronic subdural hematoma compared with burr hole evacuation alone
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  • Published on:
    Middle meningeal artery embolization versus surgical evacuation, How real-world are we?
    • Reem Almarshad, Doctor Department of neurosurgery and interventional radiology, King Fahad Hospital of the university, Imam Abdulrahman bin Faisal univ
    • Other Contributors:
      • May Adel AlHamid, Neurologist
      • Hosam Al-Jehani, Neurosurgeron and neurointerventionist

    Dear Editor,

    We have read with great interest the article entitled “Efficacy and mid-term outcome of middle meningeal artery embolization with or without burr hole evacuation for chronic subdural hematoma compared with burr hole evacuation alone” by Onyinzo, C., et al, published in Journal of NeuroInterventional Surgery (2021).

    The article has compared the Surgical and Endovascular management of (CSDH) in the elderly population who are at high risk to developing (CSDH) due to their co-morbidities and the use of anti-thrombotic agents.
    It is noted that the anti-thrombotic agents were stopped to both management arms. Upfront Middle meningeal artery embolization without stopping the anti-thrombotics, might be a strategy to mitigate the risk of cardio-embolic events.
    In regards to the evaluation of the patients outcome, clinical parameters did not include motor assessment, which is a significant factor to favor a rapid surgical evacuation in these delicate patients.
    As to the radiological follow up, cured (CSDH) were defined in the article with a thickness less than 10 mm. This is debatable as there are a lot of variations exists for this population in regards to brain volume and brain elasticity.
    Finally, we would like to point out the timing of the follow up was not defines for all patients. This need to be harmonized better to a well-defined follow up timeline. Joyce, MD, et al,2 a suggested a time frame of 6 weeks after the treatment...

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    Conflict of Interest:
    None declared.