Middle meningeal artery embolization for chronic subdural hematoma in cancer patients with refractory thrombocytopenia

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  • 1 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
  • | 2 Departments of Interventional Radiology and
  • | 3 Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas;
  • | 4 Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and
  • | 5 Department of Neurosurgery, The University of Texas Medical Branch, Galveston, Texas
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OBJECTIVE

Surgical evacuation of chronic subdural hematoma (SDH) in cancer patients is often contraindicated owing to refractory thrombocytopenia. Middle meningeal artery embolization (MMAE) recently emerged as a potential alternative to surgical evacuation for patients with chronic SDH. The goal of this study was to evaluate the safety and efficacy of MMAE for chronic SDH in cancer patients with refractory thrombocytopenia.

METHODS

A multiinstitutional registry was reviewed for clinical and radiographic outcomes of cancer patients with transfusion-refractory thrombocytopenia and baseline platelet count < 75 K/µl, who underwent MMAE for chronic SDH.

RESULTS

MMAE was performed on a total of 31 SDHs in 22 patients, with a mean ± SD (range) platelet count of 42.1 ± 18.3 (9–74) K/µl. At the longest follow-up, 24 SDHs (77%) had reduced in size, with 15 (48%) showing > 50% reduction. Two patients required surgical evacuation after MMAE. There was only 1 procedural complication; however, 16 patients (73%) ultimately died of cancer-related complications. Median survival was significantly longer in the 16 patients with improved SDH than the 6 patients with worsened SDH after MMAE (185 vs 24 days, p = 0.029). Length of procedure, technical success rate, SDH size reduction, and complication rate were not significantly differ between patients who underwent transfemoral and transradial approaches.

CONCLUSIONS

Transfemoral or transradial MMAE is a potential therapeutic option for thrombocytopenic cancer patients with SDH. However, treatment benefit may be marginal for patients with high disease burden and limited life expectancy. A prospective trial is warranted to address these questions.

ABBREVIATIONS

MMAE = middle meningeal artery embolization; SDH = subdural hematoma.

Supplementary Materials

    • Supplementary Figure 1 (PDF 155 KB)

Illustration from Serrato-Avila (pp 1410–1423). Copyright Johns Hopkins University, Art as Applied to Medicine. Published with permission.

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  • 1

    Reichman J, Singer S, Navi B, et al. Subdural hematoma in patients with cancer. Neurosurgery. 2012;71(1):7479.

  • 2

    Chan KH, Mann KS, Chan TK. The significance of thrombocytopenia in the development of postoperative intracranial hematoma. J Neurosurg. 1989;71(1):3841.

  • 3

    Furui T, Ichihara K, Ikeda A, et al. Subdural hematoma associated with disseminated intravascular coagulation in patients with advanced cancer. J Neurosurg. 1983;58(3):398401.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Morris NA, Merkler AE, Parker WE, et al. Adverse outcomes after initial non-surgical management of subdural hematoma: a population-based study. Neurocrit Care. 2016;24(2):226232.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Srivatsan A, Mohanty A, Nascimento FA, et al. Middle meningeal artery embolization for chronic subdural hematoma: meta-analysis and systematic review. World Neurosurg. 2019;122:613619.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Ban SP, Hwang G, Byoun HS, et al. Middle meningeal artery embolization for chronic subdural hematoma. Radiology. 2018;286(3):992999.

  • 7

    Kim E. Embolization therapy for refractory hemorrhage in patients with chronic subdural hematomas. World Neurosurg. 2017;101:520527.

  • 8

    Matsumoto H, Hanayama H, Okada T, et al. Which surgical procedure is effective for refractory chronic subdural hematoma? Analysis of our surgical procedures and literature review. J Clin Neurosci. 2018;49:4047.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Kan P, Maragkos GA, Srivatsan A, et al. Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations. Neurosurgery. 2021;88(2):268277.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Link TW, Boddu S, Paine SM, et al. Middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases. Neurosurgery. 2019;85(6):801807.

  • 11

    Graus F, Rogers LR, Posner JB. Cerebrovascular complications in patients with cancer. Medicine (Baltimore).1985;64(1):1635.

  • 12

    Liebman HA. Thrombocytopenia in cancer patients. Thromb Res. 2014;133(suppl 2):S63S69.

  • 13

    Edlmann E, Giorgi-Coll S, Whitfield PC, et al. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation. 2017;14(1):108.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Tanaka T, Kaimori M. Histological study of vascular structure between the dura mater and the outer membrane in chronic subdural hematoma in an adult. Article in Japanese. No Shinkei Geka. 1999;27(5):431436.

    • Search Google Scholar
    • Export Citation
  • 15

    Hashimoto T, Ohashi T, Watanabe D, et al. Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas. Surg Neurol Int. 2013;4:104.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Tempaku A, Yamauchi S, Ikeda H, et al. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: five cases and a review of the literature. Interv Neuroradiol. 2015;21(3):366371.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Ricci MA, Trevisani GT, Pilcher DB. Vascular complications of cardiac catheterization. Am J Surg. 1994;167(4):375378.

  • 18

    Kent KC, Moscucci M, Mansour KA, et al. Retroperitoneal hematoma after cardiac catheterization: prevalence, risk factors, and optimal management. J Vasc Surg. 1994;20(6):905913.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Kolkailah AA, Alreshq RS, Muhammed AM, et al. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev. 2018;4:CD012318.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Valgimigli M, Frigoli E, Leonardi S, et al. Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial. Lancet. 2018;392(10150):835848.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Rao SV, Hess CN, Barham B, et al. A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial. JACC Cardiovasc Interv. 2014;7(8):857867.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Catapano JS, Fredrickson VL, Fujii T, et al. Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment. J Neurointerv Surg. 2020;12(6):611615.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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