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  • E-188 Use of 10:1 glue hyper-dilution in middle meningeal artery embolization for chronic subdural hematomas: experience in 46 consecutive cases

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SNIS 20th annual meeting electronic poster abstracts
E-188 Use of 10:1 glue hyper-dilution in middle meningeal artery embolization for chronic subdural hematomas: experience in 46 consecutive cases
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  1. B Meyer1,
  2. J Campos2,
  3. M Khan3,
  4. D Zarrin4,
  5. J Collard de Beaufort5,
  6. G Amin3,
  7. K Golshani2,
  8. N Beaty6,
  9. M Bender7,
  10. G Colby4,
  11. L Lin3,
  12. A Coon3
  1. 1Neurosurgery, University of Arizona College of Medicine, Tucson, Tucson, AZ, USA
  2. 2Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
  3. 3Carondelet Neurological Institute, St. Joseph’s Hospital, Tucson, AZ, USA
  4. 4Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
  5. 5Syracuse University, Syracuse, NY, USA
  6. 6Neurosurgery, Florida State University, Tallahassee Memorial Hospital, Tallahassee, FL, USA
  7. 7Department of Neurosurgery, University of Rochester, Rochester, NY, USA

Abstract

Introduction/Purpose Middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematomas (cSDH) is becoming an alternative or adjunct to surgical intervention. Recent literature suggests distal embolic penetration beyond visible MMA branches achieves optimal cSDH devascularization. Here we discuss the efficiency and technical advantage of a 10:1 glue hyper-dilution for enhanced embolization of non-visable dural vasculature.

Materials and Methods A prospectively-maintained IRB-approved institutional database of the senior authors was retrospectively reviewed to identify consecutive cases where patients underwent MMA embolization with a 10:1 glue dilution paradigm with TRUFILLTM n-BCA liquid embolic.

Results The technique of 10:1 glue dilution in MMA embolization was performed for 23 patients, in 46 consecutive cases over a 5-month period (September 2022 to February 2023). Average patient age was 74 +/- 10 years (range 51-90 years), 56.5% female. Patients presented after a ground level fall (41%, n=19), with headache (13%, n=6), trauma (9%, n=4), and altered mental status (9%, n=4). Fifty-two percent of cases presented in the setting of antiplatelet or anticoagulant regimens (n=26): aspirin (30%, n=14), therapeutic anticoagulation (17%, n=8), or other antiplatelet agents (4%, n=2). On presentation, recurrent cSDHs were seen in 18 cases (40%) consisting of patients previously managed conservatively (50%, n=9), with prior burr holes (44%, n=8), versus craniotomy (5%, n=1). Average admission cSDH thickness was 10 ± 5 mm (SEM 0.89) with an average midline shift of 3 ± 3.5 mm (SEM 0.63) and right-sided laterality in 48% of cases (n=22). Bilateral embolization was performed in 91% of patients (n=21). Embolized branches of the MMA included 11 (24%) anterior, 9 (20%) posterior, and 26 (57%) both. One postprocedural complication was noted, a unilateral partial facial palsy (House-Brackmann 2), since improving on discharge with mRS 0. The technique was successfully carried out in 46/46 (100%) cases without need for periprocedural rescue surgery.

Conclusion Embolization of the middle meningeal artery with n-BCA glue is an emerging treatment strategy for cSDHs. Here we demonstrate the use of a 10:1 glue dilution for enhanced embolization of non-visible MMA branches as a treatment paradigm for thorough glue penetration and extensive embolization. Further randomized studies across embolic substances and techniques will delineate optimal cSDH treatment effects.

Abstract E-188 Figure 1
Abstract E-188 Figure 1

(A) Anterior-posterior and lateral (B) subtracted views of anterior and posterior branch MMA embolization with 10:1 glue hyper-dilution

Disclosures B. Meyer: None. J. Campos: None. M. Khan: None. D. Zarrin: None. J. Collard de Beaufort: None. G. Amin: None. K. Golshani: None. N. Beaty: 2; C; Medtronic Neurovascular, Stryker Neurovascular. 5; C; CMO of NeuroMedica. M. Bender: 2; C; Stryker Neurovascular. G. Colby: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular. L. Lin: 2; C; Medtronic Neurovascular, Stryker Neurovascular, MicroVention-Terumo, Rapid Medical, Balt. A. Coon: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular, Rapid Medical, Avail MedSystems, Imperative Care, InNeuroCo, Q’apel, Sequent Medical.

https://doi.org/10.1136/jnis-2023-SNIS.287

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