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Abstract
Background Liquid embolic agents (LEAs) such as ethylene vinyl alcohol (EVOH) are utilized for middle meningeal artery embolization (MMAE) for chronic subdural hematomas (cSDH). LEAs may be advantageous for MMAE as they are permanent and can penetrate the microvasculature of the subdural membranes. LEA surface area (SA) can quantify this penetration. The segmentation of LEA SA is not described in the literature and may be of interest in refining MMAE technique.
Methods We retrospectively collected computerized tomography (CT) scans from 74 patients (with 95 cSDH) who underwent first-line MMAE with EVOH. Non-contrast head CTs were acquired pre-embolization, immediately post-embolization and at 1-, 3-, and 6 month follow-up. A 3D-Slicer was used to segment hematoma volumes and the liquid embolic cast. We hypothesized that greater LEA SA would be correlated with greater improvements in cSDH volumetric resolution.
Results There was significant resolution in cSDH volumes over the follow-up period compared to preoperative volume (p<0.0001). The LEA SA was significantly correlated with the rate of cSDH resolution at 3 months (R2=0.08, p=0.03), and 6 months (R2=0.14, p=0.01).
Conclusions The correlation of LEA surface area with hematoma resolution at 3-months and 6-months suggests greater LEA penetration may improve radiographic outcomes. This study uniquely provides a quantitative radiological perspective on the effect of LEA penetration on cSDH resolution.
- embolic
- subdural
- angiography
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
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Contributors KJ collected the data, performed segmentation and statistical analysis, and drafted the manuscript. SS performed segmentation and statistical analysis and drafted the manuscript. KJ and SS contributed equally to the study. TK contributed to segmentation techniques. RD contributed to conceptualization of the study, performed interventions, and critically revised the manuscript. DF conceptualized the study, performed interventions, and critically revised the manuscript. CS is the guarantor and contributed to data collection, development of analysis methodology, and critical revision of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests DF has received consulting, proctoring, and research support from Medtronic Neurovascular and is on the Editorial Board of JNIS. CS has received research support from Medtronic Neurovascular and Siemens Healthineers. TK is currently an employee of Siemens Healthineers.
Provenance and peer review Not commissioned; externally peer reviewed.
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