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
Bibliographic record
Abstract
<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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".