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

Sungho Lee, Aditya Srivatsan, Visish M. Srinivasan, Stephen R. Chen, Jan Karl Burkhardt, Jeremiah N. Johnson, Daniel M.S. Raper, Jeffrey S. Weinberg, Peter Kan

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1273-1277
Number of pages5
JournalJournal of neurosurgery
Volume136
Issue number5
DOIs
StatePublished - May 1 2022
Externally publishedYes

Keywords

  • cancer
  • embolization
  • endovascular neurosurgery
  • interventional neurosurgery
  • middle meningeal artery
  • oncology
  • subdural hematoma
  • thrombocytopenia
  • vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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