Introduction Assessments of the Middle Meningeal Artery (MMA) Embolization have not been widely reported in community hospital settings. Moreover, there is a lack of clinical guidelines for repeated adult head CT use during the treatment of chronic subdural hematoma (cSDH). This study aims to illustrate the clinical and radiographic outcomes of MMA embolizations performed at a community hospital and assess the frequency of administered CT scans.
Materials and Methods Fifty consecutive patients with cSDH (32% female) who underwent MMA embolization between July 18, 2019 and February 9, 2023 were retrospectively recruited. Thirty-two of these patients underwent at least one craniotomy procedure for evacuation of the SDH. Demographics, CT records, clinical outcomes, and patient-reported outcomes were examined (table 1). Viz RECRUIT SDH analyzed 325 head CTs to conduct automatic segmentation and measure SDH thickness, midline shift, and volume. Each patient’s measurements from the scan closest to each designated time point (pre-craniotomy (if applicable), pre-embolization, 30-days post embolization, 6-months post embolization) were selected for analysis to establish the most consistent representation of hematoma resolution. In a separate analysis, a comparison of patient outcomes between those who received fewer or greater than the median number of scans was also performed.
Results Patients received a median of seven CT scans (including CT angiogram and CT perfusion) during their treatment. Patients received a combined total average radiation of 1,180 mGy (412 mGy average CT radiation + 768 mGy average intra-operative radiation for embolization). As shown in the table 1, linear regression at the four time points showed a significant difference in mean SDH thickness, midline shift, and volume (p < 0.001). However, there was no significant effect of the presence of a craniotomy on the mean values of the three measurements (p > 0.05). We also compared patients who received fewer than seven scans and those who received seven or more. All post-operative SDH measurements and patient-reported outcomes comparisons were non-significant except for the average 30-day GHS Mental Health T score, which was significantly better for patients receiving fewer than seven scans than those with seven or more (54.06 vs. 47.52; p=0.04). These results suggest caution in the administration of repetitive CT scans given similar patient outcomes and an already high exposure to radiation.
Conclusion In this single-center community hospital study, patients with MMA embolization procedures with or without craniotomies showed similar hematoma progression over six months using novel SDH measurements through Viz SDH. Results suggest a need for better CT use guidelines in this population as frequent CT scans were associated with worse mental health outcomes at 30 days while resulting in similar functional outcomes at all follow up points.
Disclosures M. Chung: None. J. Rutledge: None. L. Lombardo: None. D. Altschul: 2; C; Viz.ai.
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