There’s a safer and smarter way.
After a head injury or fall, particularly in older adults, a dangerous accumulation of blood and fluid can develop between the brain’s surface and its protective covering, the dura. This condition, known as a subdural hematoma, often necessitates surgical intervention. However, a recent study suggests a more effective method that significantly reduces the likelihood of repeat surgeries.
According to Dr. Jared Knopman, co-lead author of the study and director of cerebrovascular surgery and interventional neuroradiology at Weill Cornell Medicine in New York City, the recurrence of blood accumulation after initial surgery presents a significant challenge, especially for seniors who are most affected by chronic subdural hematomas.
The innovative approach, detailed in the New England Journal of Medicine on November 21, combines traditional hematoma surgery with a procedure called embolization of the brain’s middle meningeal artery. This minimally invasive technique uses a substance to “seal off” the artery, preventing further bleeding and reducing the need for additional surgeries.
The embolization process involves threading a catheter through blood vessels in the wrist or groin to deliver a liquid embolic agent called Onyx, which blocks the middle meningeal artery. Onyx, developed by Medtronic (the study’s sponsor), essentially acts as a glue to stop the artery from contributing to hematoma recurrence.
In the trial, 400 patients averaging 72 years old were treated at 39 medical centers. They were divided into two groups: one received only standard hematoma surgery, while the other underwent the combined surgery and embolization approach. Results showed that 11.3% of patients treated with surgery alone required a second operation within three months, compared to just 4% of those who received the combined treatment—a nearly threefold reduction.
Dr. Knopman emphasized the significance of these findings, noting that this discovery sheds light on an overlooked aspect of the brain’s anatomy and its role in hematoma recurrence. Meanwhile, co-author Dr. Jason Davies, associate professor of neurosurgery at the University at Buffalo, highlighted the difficulties of treating hematomas in patients taking blood thinners, which exacerbate the risk of ongoing bleeding.
Left untreated, subdural hematomas can grow and place dangerous pressure on the brain, impairing its function. The new combined approach offers a transformative solution, minimizing risks and improving patient outcomes. “This represents a paradigm shift,” Davies stated. “We’re moving from a condition that often demands multiple surgeries to one that can be effectively managed with a minimally invasive procedure.”
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