After head trauma, subdural hematomas, a dangerous pooling of blood between the brain and its protective covering, often necessitate surgery. A recent study published in the New England Journal of Medicine suggests a more effective approach: combining standard surgery with embolization of the middle meningeal artery to reduce the need for repeat operations.
The study, involving 400 patients with subdural hematomas across 39 medical centers, found that the combined approach significantly reduced the rate of repeat surgeries. Patients, averaging 72 years of age, either underwent standard hematoma surgery or surgery combined with embolization using Onyx, a liquid embolic agent manufactured by Medtronic.
Onyx Embolization Technique
The embolization procedure involves threading a small catheter containing Onyx into the middle meningeal artery, effectively blocking it. This minimally invasive technique, performed via vessels in the wrist or groin, prevents the artery from contributing to hematoma recurrence.
The results indicated a substantial improvement: only 4% of patients who received the combined treatment required a second surgery within three months, compared to 11.3% of those who underwent surgery alone. According to Dr. Jared Knopman, co-lead author and director of cerebrovascular surgery and interventional neuroradiology at Weill Cornell Medicine, sealing off the middle meningeal artery with Onyx is crucial for improving outcomes.
Impact on Patients on Blood Thinners
Dr. Jason Davies, co-lead author from the University at Buffalo, emphasized the particular challenges in preventing re-bleeds in older patients on blood thinners. He noted that up to 20% of hematomas become chronic and require multiple surgeries, increasing costs and risks. The new combo approach offers a potential solution by changing subdural hematoma treatment from a disease requiring multiple surgeries to one manageable with a minimally invasive procedure and better outcomes.
A Paradigm Shift in Treatment
"We are changing the way that we are treating this very common disease," Davies stated in a university news release. "We are changing subdural hematoma from being a disease that commonly requires multiple surgeries to a disease that can be better treated with a simple, minimally invasive procedure that produces better outcomes."
