{
  "abstract": "Background Craniotomy for subdural hematoma (SDH) in elderly patients with comorbidities can be challenging. The Subdural Evacuating Port System (SEPS; Medtronic, Minneapolis, MN) offers a less invasive alternative, while middle meningeal artery embolization (MMAE) has shown effectiveness in preventing SDH recurrence. We evaluated the combined effectiveness of SEPS+MMAE for chronic SDH (cSDH) treatment.Methods Retrospective database reviews were conducted. Demographic, comorbidity, procedural, and outcomes data were analyzed. cSDH resolution was tracked by measuring hematoma volumes on noncontrast computed tomograms pre-SEPS+MMAE, 24–48 hours post-SEPS+MMAE, and 6–8 weeks afterward (follow-up-SEPS+MMAE).Results Our study included 114 patients (median age: 77 years (interquartile range (IQR): 69–83 years); men: women=74:40) with 134 cSDHs treated with SEPS+MMAE were included. Median pre-SEPS+MMAE cSDH volume was 122.9 mL (88–152.4 mL) with midline shift of 6 mm (3.4–9.5 mm). Most MMAE procedures were performed under general anesthesia (68.7%), utilizing the femoral approach (61.9%) and particle embolic agents (55.2%). In-hospital rescue craniotomy was required after 10 (7.5%) procedures. Median post-SEPS+MMAE and follow-up-SEPS+MMAE cSDH volume reductions were 71.1 mL (54.1–94.8 mL) and 23.4 mL (2–56.3 mL), respectively, resulting in 38.1% (22.1–52.9%) and 79.9% (51–97.8%) reductions, respectively. Of 109 patients with follow-up, 10 (9.2%) were readmitted for cSDH residual/recurrence within 90 days, eight (7.3%) required retreatment: five (4.6%) with craniotomy, three (2.8%) with SEPS. Hyperlipidemia (P=0.002), anticoagulant use (P=0.036), and larger pre-SEPS+MMAE cSDH volume (P<0.001) predicted greater SEPS-mediated clearance. Older age (P=0.03), coronary artery disease (P=0.004), membranes within cSDH (P=0.039), acute/subacute components in cSDH (P=0.047), and unilateral cSDH (P=0.017) predicted less SEPS-mediated clearance. Older age (P=0.006), acute/subacute components in cSDH (P=0.016), and longer follow-up (P=0.013) predicted higher MMAE effectiveness. Higher pre-SEPS+MMAE cSDH volume (P=0.047) and unilateral MMAE for bilateral cSDH (P=0.036) predicted lower MMAE effectiveness.Conclusion SEPS+MMAE was an effective, safe treatment for cSDH.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"
      ],
      "name": "Jaims Lim"
    },
    {
      "affiliations": [
        "Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"
      ],
      "name": "Vinay Jaikumar"
    },
    {
      "affiliations": [
        "Neurosurgery, Albany Medical Center, Albany, New York, USA"
      ],
      "name": "Alexandra R Paul"
    },
    {
      "affiliations": [
        "Neurosurgery, Albany Medical Center, Albany, New York, USA"
      ],
      "name": "Matthew Cullen"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Christopher P Kellner"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "J Mocco"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Brandon D Philbrick"
    },
    {
      "affiliations": [
        "Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, Florida, USA"
      ],
      "name": "Kunal Vakharia"
    },
    {
      "affiliations": [
        "Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut, USA"
      ],
      "name": "Patrick Wahlig"
    },
    {
      "affiliations": [
        "University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Marissa D Kruk"
    },
    {
      "affiliations": [
        "Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA",
        "Neurosurgery and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Kenneth V Snyder"
    },
    {
      "affiliations": [
        "Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA",
        "Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Elad I Levy"
    },
    {
      "affiliations": [
        "Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA",
        "Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Jason M Davies"
    },
    {
      "affiliations": [
        "Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA",
        "Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Adnan H Siddiqui"
    }
  ],
  "title": "Effectiveness of subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas – a multicenter experience",
  "uid": "688f3351-a8fe-547e-98ce-3c06519bfc3e"
}