- Department of Neurology, Neurology and Neurophysiology Center, Vienna, Austria
Correspondence Address:
Josef Finsterer, Department of Neurology, National Competence Centre, Vienna, Austria.
DOI:10.25259/SNI_587_2024
Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Finsterer J. The outcome of a subdural hematoma after embolization of the middle meningeal artery depends on many influencing factors. Surg Neurol Int 09-Aug-2024;15:279
How to cite this URL: Finsterer J. The outcome of a subdural hematoma after embolization of the middle meningeal artery depends on many influencing factors. Surg Neurol Int 09-Aug-2024;15:279. Available from: https://surgicalneurologyint.com/surgicalint-articles/13031/
Dear Editor,
We read with interest the article by Imai et al. on a single-center retrospective study of the outcome of 72 patients after the first recurrence of chronic subdural hematoma (SDH).[
The first point is that the number of patients included in the study was too small to conclude, as reported. Prospective, multicenter, and large-scale studies are needed to determine the optimal timing of MMAE for embolization after the first recurrence of SDH.
The second point is that SDH can originate not only from branches of the middle meningeal artery (MMA) but also from branches of the anterior or posterior meningeal artery. Therefore, MMAE may not be effective if it has not been clearly established before embolization whether the hemorrhage actually originates from an MMA branch. Were all 17 patients who underwent MMAE also searched for the source of bleeding?
The third point is that the study period included the time of the pandemic. Therefore, we should know how many of the 72 included patients were severe-acute-respiratory-syndrome-related coronavirus-2 (SARS-CoV-2) positive at the time of SDH recurrence. Knowing the number of infected individuals is crucial because SARS-CoV-2 infections can be complicated by SDH[
One limitation of the study is that hereditary coagulopathies were not sufficiently excluded as a cause of SDH. Another limitation is that the follow-up period was short, and since the recurrence rate depends on the duration of follow-up, especially in the patients classified as cured, we should know how many of the patients classified as cured had a recurrence of SDH at 6 or 12 months follow-up.
To summarize, this interesting study has limitations that put the results and their interpretation into perspective. Addressing these limitations could strengthen the conclusions and corroborate the study’s message. Multicenter studies with large cohorts are needed before the optimal timing for embolization of MMA in patients with recurrent SDH can be determined. Since one-third of the patients who underwent embolization relapsed,[
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References
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2. Imai N, Kato T, Ito Y, Morishima R, Aki T, Shirakami SI. Timing of chronic subdural hematoma treatment affects middle meningeal artery embolization outcome. Surg Neurol Int. 2024. 15: 214
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