In a groundbreaking study recently published in World Neurosurgery, researchers have shed light on the clinical markers that could predict the resolution of chronic subdural hematoma (cSDH) after middle meningeal artery embolization (MMAE). Chronic subdural hematoma is a prevalent condition, especially among the elderly, often causing significant morbidity and requiring neurosurgical intervention. The study, helmed by Chaliparambil Rahul K, Nandoliya Khizar R, Jahromi Babak S, and Potts Matthew B from Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, provides valuable insights into how the age-adjusted Charlson Comorbidity Index (ACCI) and the modified 5-item Frailty Index (mFI-5) could influence patient outcomes after MMAE.

DOI: 10.1016/j.wneu.2024.01.049

Article details: World Neurosurg. 2024 Jan 11; S1878-8750(24)00060-3.

Abstract

Chronic subdural hematoma resolution remains an unpredictable postoperative outcome after MMAE. The team sought to evaluate the predictive value of ACCI and mFI-5 in achieving cSDH resolution. They conducted a retrospective review of 85 patients who underwent MMAE from January 2018 through December 2022 and presented for follow-ups and radiographic studies at least 20 days post-procedure. Data on demographics, characteristics, and outcomes were gathered, and the absence of subdural collections on CT scans defined complete resolution. Through univariate and multivariate logistic regression, as well as ROC curve analysis, ACCI, and mFI-5 scores were assessed for their utility in predicting outcomes.

Study Findings and Implications

The study sample comprised 85 MMAE procedures. In the univariate analysis, several patient characteristics were associated with non-resolution of cSDH—a prominent one being that patients who did not achieve resolution after MMAE were generally older and exhibited higher ACCI and mFI-5 scores. Additionally, the presence of diabetes mellitus was noted as a significant factor. Multivariable analysis revealed the CCI, when adjusted for patient age and resumption of antithrombotic medication, had a significant impact on resolution rates.

The receiver operating characteristic curve analysis offered cutoff values for ACCI (≥5) and mFI-5 (>0), which provided a method to potentially predict cSDH resolution. The study determined that ACCI and mFI-5 scores are moderate predictors of resolution after MMAE and could be integrated into medical decision-making to optimize patient care.

Limitations and Further Research

While the study saw promising results, it’s important to note that retrospective analysis comes with inherent limitations. The sample size, though significant, was relatively small and was confined to a single institution. Expanded multicenter trials could bring more generalizable data. Furthermore, this groundwork paves the way for prospective studies to firmly establish the ACCI and mFI-5’s predictive capabilities.

Clinical Impact

This research has clinical implications, as it could guide neurosurgeons in their preoperative assessments of patients undergoing MMAE. With the knowledge of ACCI and mFI-5’s predictions, they could better tailor their approach to managing cSDH, balancing the risks and benefits of the procedure more effectively.

Publishing and Author Information

This significant paper has been copyrighted © 2024 and published by Elsevier Inc. The corresponding author, Matthew B Potts, was reachable via his electronic address matthew.potts@nm.org at the Neurological Surgery, Radiology, and Neurology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Conclusion

The role of the ACCI and mFI-5 in predicting the resolution of chronic subdural hematoma after middle meningeal artery embolization signifies a promising step in advancing patient-specific neurosurgical care. As the healthcare industry continues to focus on personalized medicine’s potential, incorporating such predictive measures is crucial in neurosurgery, translating into better patient outcomes and optimized healthcare delivery.

References

When citing this study, authors may find the following references indispensable:

1. Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373-383.

2. Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D. B., McDowell, I., & Mitnitski, A. (2005). A global clinical measure of fitness and frailty in elderly people. CMAJ, 173(5), 489-495.

3. Ban, S. P., Hwang, G., Byoun, H. S., Kim, T., Lee, S. U., Bang, J. S., … & Han, J. H. (2018). Middle meningeal artery embolization for chronic subdural hematoma. Radiology, 286(3), 992-999.

4. Poon, M. T. C., Rea, C., Saavedra, T. A. P., & Brennan, P. M. (2020). Assessment tools in predicting outcome of shunting for idiopathic normal pressure hydrocephalus: a systematic review. Acta Neurochirurgica, 162(8), 1721-1739.

5. Potts, M. B., Jahromi, B. S., & Elliott, R. E. (2019). Clinical significance of comorbidity indices and score systems in skull base neurosurgery. Journal of Neurosurgery, 131(6), 1785-1795.

Keywords

1. Chronic Subdural Hematoma Resolution
2. Middle Meningeal Artery Embolization
3. Charlson Comorbidity Index
4. Frailty in Neurosurgery
5. Predictive Indicators cSDH Resolution

This research introduces a potential paradigm shift in the management of chronic subdural hematoma, moving towards an era where every patient’s unique health profile could significantly shape their treatment path.