[en] [en] INTRODUCTION: Middle Meningeal Artery Embolization (MMAE) in patients with chronic SubDural Hematoma (cSDH) is a novel treatment approach, albeit the specific role of MMAE in the treatment of cSDH is not yet defined.
RESEARCH QUESTION: The aim of this work is to provide a consensus-based statement from a multidisciplinary panel on the current role of MMAE in patients with cSDH.
MATERIALS AND METHODS: A literature search was performed using the keywords MMAE and cSDH. Based on the available published data, the panel was asked if a consensus could be reached on the role of MMAE in both de novo as well as in recurrent cSDH.
RESULTS: The panel reached a consensus on the current role of MMAE in both de novo- and recurrent cSDH, as well as in patients on antithrombotics and those with coagulopathy. MMAE should be considered in the following scenarios:1)As "stand-alone" treatment in de novo cSDH requiring intervention but where surgery is prevented due to either coagulopathy or in patients on antithrombotics in whom the risk of suspension is considered unacceptably high,2)as "stand-alone" treatment in recurrent cSDH requiring intervention but where surgery is prevented due to either coagulopathy or in those on antithrombotics in whom the risk of suspension is considered unacceptably high and3)as "adjunct to surgery" in all recurrent cSDH.
DISCUSSION AND CONCLUSION: This statement is to be considered an expert consensus opinion of delegates representing key international medical societies of specialists involved in the care of cSDH patients.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Bartek, J; EANS Delegate, Dep. of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
Biondi, A; WFITN Delegate, Department of Interventional Neuroradiology, Besançon University Hospital, F-25000, Besançon, France ; Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, Université Bourgogne Franche-Comté, F-25000, Besançon, France
Bonhomme, Vincent ; Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Iaccarino, C; NTC-WFNS Delegate, Advisory Group of the Neurotraumatology Committee of the WFNS, Neurosurgery, School of Neurosurgery, University of Modena and Reggio Emilia, Italy ; Neurosurgery Division, University Hospital of Modena, Modena, Italy ; Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
Kulcsar, Z; ESMINT Delegate, Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
Möhlenbruch, M A; ESNR Delegate, Neuroradiology, Heidelberg University Hospital, Heidelberg Germany
Raabe, A; EANS Delegate, Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
Rickard, F; EuGMS Delegate, Consultant Geriatrician and Perioperative Physician, North Bristol NHS Trust, Bristol, UK
Romero, C S; ESAIC Delegate, Department of Anaesthesia and Intensive Care Medicine, University General Hospital, European University of Valencia, Spain
Schubert, T; ESMINT Delegate, Department of Neuroradiology, Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland
D, Shipway; EuGMS Delegate, Consultant Physician & Perioperative Geriatrician, North Bristol NHS Trust, Bristol, UK ; Chair, British Geriatric Society Perioperative Medicine Group, UK ; Honorary Senior Clinical Lecturer, University of Bristol, UK
Sicignano, C; AINR Delegate, Neuroradiology, Ospedale Del Mare, Naples, Italy
Muto, M; ESNR Delegate, Diagnostic and Interventional Neuroradiology, Cardarelli Hospital, Naples, Italy
Editorial assistance and project facilitation was provided by Alison Crowe. This document is approved by the European Association of Neurosurgical Societies (EANS); the Guidelines Committee of the European Society for Minimally Invasive Neurological Therapy (ESMINT); the Interventional Neuroradiology Committee of the European Society of Neuroradiology (ESNR); the European Geriatric Medicine Society (EuGMS); the European Society of Anaesthesiology and Intensive Care (ESAIC); the Italian Society of Neurosurgery (SINCh); the Italian Association of Diagnostic and Interventional Neuroradiology (AINR); the World Federation of Interventional and Therapeutic Neuroradiology (WFITN); and the Neurotraumatology Committee (NTC) of the World Federation of Neurosurgical Societies (WFNS).Corrado Iaccarino reports educational grants from Integra Life Science and Finceramica S.p.A.Lucio Castellan reports research funding from Roche, Biogen, Stryker; Advisory board activities for VMLY Seagen and Honoraria for lectures from Seagen, Balt and H2O.
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