The Potential of Embolization as a Treatment Approach for Subdural Hematomas: Jason M. Davies, MD, PhD

WATCH TIME: 3 minutes

"Sometimes patients with subdural hematomas are predominantly cared for by neurosurgeons or neurologists but I think we need the entire neuroscience community to be aware that these patients benefit with very low rates of complications from this procedure."

Chronic subdural hematomas (SDH) is one of the most prevalent neurosurgical diseases and despite advancements in surgical evacuation, research shows that it is associated with significant morbidity and mortality. According to a study published in Geroscience, 30% of patients are expected to have hematoma recurrence and need to repeat surgical evacuation, and 20% are expected to lose independence and require long-term care.¹ The rationale behind middle meningeal artery (MMA) embolization is to halt the perpetuating cycle of hematoma persistence, aiming to stop chronic SDH at its source.

The EMBOLISE (NCT04402632) trial investigated the use of Onyx Liquid Embolic System (LES) embolization of the MMA as an adjunct to conventional treatment for symptomatic subacute or chronic SDH. Presented at the 2024 International Stroke Conference (ISC), held February 7-9, in Phoenix, Arizona, results showed that treatment with the embolization system had a 3-fold decrease in the rate of hematoma recurrence/progression requiring surgical drainage, the primary end point, at 90 days.² The study included 400 patients, randomly assigned 1:1 to either surgery alone or surgery with adjunctive MMA embolization, across 39 US centers.

At the 2024 American Academy of Neurology (AAN) Annual Meeting, held April 13-18, in Denver, Colorado, lead investigator Jason M. Davies, MD, PhD, presented on the latest findings from EMBOLISE in a session that covered landmark clinical trials that impact patient care in neurology. Davies, an assistant professor of neurosurgery and biomedical informatics at the State University of New York at Buffalo, sat down with NeurologyLive^® at the meeting to discuss the primary considerations in choosing embolization as a treatment for SDH. He also talked about the use of the Onyx device contributes to the safety and efficacy of the procedure. In addition, Davies potential applications beyond SDH are being explored for similar embolization procedures.

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REFERENCES
1. Debs LH, Walker SE, Rahimi SY. Newer treatment paradigm improves outcomes in the most common neurosurgical disease of the elderly: a literature review of middle meningeal artery embolization for chronic subdural hematoma. Geroscience. Published online May 1, 2024. doi:10.1007/s11357-024-01173-5
2. Knopman J, Davies JM, Harbaugh RE, et al. The EMBOLISE study: embolization of the middle meningeal artery with Onyx Liquid Embolic System in the treatment of subacute and chronic subdural hematoma. Presented at: International Stroke Conference; February 7-9, 2024; Phoenix, AZ. LB28