Blocking Artery Supplying Brain Covering After Subdural Hematoma Reduces Repeat Surgery

A subdural hematoma is a condition where a tear in the blood vessels between the brain's surface and its protective membranes causes blood accumulation. This can result from physical trauma, such as a car accident, but can also develop gradually after the injury. A subacute subdural hematoma, typically following less severe trauma like a concussion, presents symptoms like weakness, numbness, seizures, headaches, confusion, or dizziness that evolve over hours or days post-injury. Chronic subdural hematoma, where blood pools between the brain and its outer covering, is a common reason for neurosurgery, particularly in the elderly due to age-related brain structural changes and increased use of blood thinners. Treatment options for subacute or chronic subdural hematomas may include surgical drainage of the pooled blood or careful symptom monitoring to decide if and when intervention is needed. However, even after surgery, up to 20% of cases may require additional surgery. Now, a clinical trial has found that blocking an artery supplying blood to the dura, in conjunction with surgical removal of pooled blood, can nearly triple the reduction in the likelihood of blood reaccumulation and the need for additional surgery.

The findings of the EMBOLISE clinical trial conducted by researchers at the State University of New York (Buffalo, NY, USA) were presented at the International Stroke Conference 2024 held by the American Stroke Association (Dallas, TX, USA). The EMBOLISE clinical trial explored whether additional surgery for a subacute or chronic subdural hematoma is less likely when, besides surgical drainage, a substance is injected to embolize (block) an artery supplying blood to the dura. The trial used the Onyx liquid embolic system, already employed in surgeries for abnormal artery-vein connections in the brain, to minimize bleeding. From December 2020 to August 2023, 400 adults (average age 72, 27% women) from 39 centers, including community and academic hospitals, participated. All participants were preparing for subdural hematoma surgery and were deemed capable of self-care and likely to survive at least a year.

The patients were randomly assigned to either surgery alone or surgery plus embolization using the liquid embolic system. The primary measure was the frequency of blood reaccumulation requiring surgical drainage within 90 days. The results showed that blood reaccumulation and the need for surgical drainage within 90 days occurred in 4.1% of patients receiving surgery plus embolization, compared to 11.3% in the surgery-only group. At 90 days post-surgery, both groups showed comparable levels of increased disability and neurological dysfunction, with 11.9% in the surgery plus embolization group and 9.8% in the surgery-only group. Serious adverse events related to embolization were observed in 2% of patients who underwent the procedure.

“The EMBOLISE trial showed that there was a nearly 3-fold reduction in re-operation for patients that were treated with surgery plus embolization,” said study co-author Jason Davies, M.D., Ph.D., an associate professor in the departments of neurosurgery and biomedical informatics at the State University of New York. “Fewer trips to the operating room mean less potential for pain, complications, recovery and expense for the patient. Furthermore, we see that the complications related to the embolization procedure were low and that there was no increase in neurological problems.”

Related Links:
State University of New York
American Stroke Association 

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