P-035 The clinical outcome and recurrence rate of chronic subdural hematoma after surgical drainage vs. embolization of MMA (EMMA): a comparison of retrospective cohort studies
Notice bibliographique
Résumé
<h3>Background</h3> Chronic subdural hematoma (CSDH) is of the most encountered neurosurgical cases, predominantly in older individuals. Chronic subdural hematoma (CSDH) is the accumulation of liquified blood products in the space between the dura and the arachnoid. CSDH has an incidence of 17.6/100,000/year that has more than doubled in the past 25 years in parallel with an aging population. Surgical drainage remains the mainstay of treatment yet is challenged by variable recurrence rates. CSDH has also been identified as a sentinel event leading to increased mortality particularly in younger age groups with a standardized mortality ratio of 17 in the 55 – 64-year-old group. Surgical treatment significantly decreases mortality even in the very elderly (age > 90) population; however, rates of recurrence of 10.1% – 29% are associated with poor outcomes. Less invasive methods of embolization of the middle meningeal artery (EMMA) could reduce the recurrence rates. The purpose of this study is to compare the radiological and clinical outcomes of surgical vs. EMMA intervention for the treatment of CSDH at our tertiary care center. <h3>Methods</h3> The study was approved by our institutional research ethics board (REB number-B2020:077). Consecutive patients undergoing surgical intervention for CSDH from January 2019 to mid-2020, and those undergoing EMMA from July 2020 to September 2021 at our center were retrospectively included. Surgical interventions included Burr Hole Craniotomy (BHC) and craniotomy. EMMA procedures were performed using polyvinyl alcohol (PVA) particles or liquid embolic agent (LEA) based on the operator’s preference. Demographic and clinical details were collected through chart reviews. The outcome of the procedures and complications were assessed by the operators themselves.Qualitative and analytical statistical analysis was performed. Peri-procedural radiographic information and follow-ups were also included as per standard of care. <h3>Results</h3> A total of 102 patients undergoing surgical intervention (mean age- 69.0 years; range -21–100 years; Male -79) were compared to 20 patients receiving EMMA (mean age – 65.6 years; range- 14–85 years; Male – 16) as definite treatment for CSDH. The recurrence rate of CSDH post-procedure was 23 (22.55%) for surgical compared to none (0%) for EMMA (P = 0.02). Furthermore, the morbidity and mortality associated with surgical interventions were 20 (19.6%) and 12(11.8%), compared to 0% (P = 0.03) and 0% (P = 0.11) for EMMA, respectively. <h3>Conclusion</h3> Based on our limited data, EMMA has shown to be a promising method in reducing the recurrence, morbidity, and mortality risks to a minimum when compared to traditional surgical interventions for CSDH. Further supporting evidence from the ongoing randomized controlled trials is needed to better establish the superiority of EMMA to surgical interventions and to potentially shift the standard of care to a new, less invasive direction. <h3>Disclosures</h3> <b>N. Atefi:</b> None. <b>J. Dian:</b> None. <b>J. Silvaggio:</b> None. <b>J. McEachern:</b> None. <b>Z. Kaderali:</b> None. <b>J. Shankar:</b> None.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».