E-196 Middle meningeal artery embolization for chronic subdural hematoma in thrombocytopenic cancer patients
Year: 2024
Type: conference-abstract
Abstract: Introduction Chronic subdural hematoma (cSDH) is more common in cancer patients with thrombocytopenia associated with either the underlying cancer or cytotoxic treatment effects. Given the relatively higher frequency of cSDH in cancer patients and the higher risk associated with open surgery in this patient population, middle meningeal artery embolization (MMAE) is a potential treatment strategy which may reduce the need for open surgical evacuation, minimize interruption in oncologic treatment and reduce the use of platelet transfusions. Method We performed a retrospective review of all MMAE for cSDH performed in a 5-year period in patients with cancer and evaluated clinical outcomes after MMAE. Results Total of 81 patients with 108 cSDH underwent MMAE. All patients had a cancer diagnosis and 70/81 patients received active cancer treatment within 6 weeks of the cSDH diagnosis. 69/81 patients were thrombocytopenic at the time of cSDH diagnosis with a platelet count of < 100K or other form of coagulopathy. Sixty-one patients (61/81, 75.3%) with eighty cSDH (80/108, 74.1%) were asymptomatic or mildly symptomatic from the cSDH. MMAE was successfully performed in 104/108 cSDH with PVA particles only (10%), PVA particles and coils (69%), liquid embolic agents (16%), liquid embolic agents and coils (2%) and coils only (3%). At 3-months follow up, 31/108 cSDH (28.7%) demonstrated interval stability (less than 25% increase or reduction in the size of the cSDH) and 48/108 cSDH (44.4%) demonstrated >25% reduction. 29/108 cSDH (26.9%) demonstrated >25% increase in size with 4 cSDH (3.7%) requiring rescue surgical evacuation. Two patient experienced acute hemorrhage into the cSDH which were asymptomatic and resolved without treatment. No other adverse event was encountered. At final follow up, 36/81 (44.4%) patients were alive. Conclusion Chronic subdural hematoma can be safely treated by MMAE in asymptomatic or mildly symptomatic cancer patients with thrombocytopenia and coagulopathy, with 79/108 cSDH (73.1%) demonstrating interval stability or >25% reduction in hematoma size. Only 4 cSDH (3.7%) in 4 patients required rescue surgical evacuation due to hematoma enlargement and development of symptoms. Future prospective clinical trial will be necessary to compare upfront MMAE vs. watchful observation for rates of hematoma expansion and need for surgical evacuation in this high surgical risk patient population. Disclosures C. Young: None. P. Kan: None. J. Weinberg: None. F. Lang: None. S. Chen: None.
Authors: C Young, P Kan, J Weinberg, F Lang, S Chen
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4400893680