O-021 Concurrent middle meningeal artery embolization for treatment of chronic subdural hematomas
Bibliographic record
Abstract
<h3></h3> Non-acute subdural hematomas (NASHs) are expected to be the most common cranial neurosurgery pathology encountered by the year 2030. Treatment with surgical evacuation may be necessary, but the rate of recurrence after surgical intervention has been reported to be as high as 30%. Minimally invasive middle meningeal artery embolization (MMAe) during the perioperative period has been posited as an adjunctive treatment to decrease recurrence after surgical evacuation of NASH. The authors evaluated the safety and efficacy of MMAe in a multi-institutional cohort. Data from 145 patients with NASH who underwent surgical evacuation and concurrent MMA embolization in the perioperative period were retrospectively collected from 15 institutions. The primary outcome was rates of NASH recurrence requiring repeat surgical intervention. We collected clinical data including use of anticoagulants and/or antiplatelets, prior treatment of NASH, and perioperative platelet counts; treatment data including anesthesia type, type of embolic agent, length of hospital stay, and access type; and radiographic data including laterality of the NASH, presence of subdural membranes, MMA size, presence of dangerous collaterals, and median width of the NASH at initial presentation, after evacuation, and at 90-day follow-up. This data can be seen in table 1. Radiographic features of the NASHs at last follow-up were included size reductions/improvements. Radiographic features at last follow-up are summarized in table 2. Outcomes data collected included: mortality, adverse events, and modified Rankin Scale (mRS) score at last follow-up, results can be seen in table 3. The median preoperative hematoma width was 18 mm, and subdural membranes were present on imaging in 87% of patients. At 90-day follow-up, the median NASH width was 6 mm, and 51% of patients had at least a 50% decrease of NASH size. At last clinical follow up, 87% had the same or improved mRS score. Eight percent of treated NASHs had recurrence requiring additional surgery. The total all-cause mortality was 6%. This study provides evidence from a multi-institutional cohort that performing concurrent MMAe in the perioperative period as an adjunct to surgical evacuation is a safe and effective means to reduce surgical recurrence in patients with NASHs. <h3>Disclosures</h3> <b>W. Salah:</b> None. <b>C. Baker:</b> None. <b>J. Scoville:</b> None. <b>J. Hunsaker:</b> None. <b>C. Ogilvy:</b> None. <b>J. Moore:</b> None. <b>H. Riina:</b> None. <b>E. Levy:</b> None. <b>A. Spiotta:</b> None. <b>B. Jankowitz:</b> None. <b>C. Cawley:</b> None. <b>A. Khalessi:</b> None. <b>O. Tanweer:</b> None. <b>R. Hanel:</b> None. <b>B. Gross:</b> None. <b>O. Kuybu:</b> None. <b>A. Nguyen Hoang:</b> None. <b>A. Baig:</b> None. <b>M. Khorasanizadeh:</b> None. <b>A. Mendez:</b> None. <b>G. Cortez:</b> None. <b>J. Davies:</b> None. <b>S. Narayanan:</b> None. <b>B. Howard:</b> None. <b>M. Lang:</b> None. <b>A. Siddiqui:</b> None. <b>A. Thomas:</b> None. <b>P. Kan:</b> None. <b>J. Burkhardt:</b> None. <b>M. Salem:</b> None. <b>R. Grandhi:</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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| 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".