Middle meningeal artery embolisation for chronic subdural haematomas
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3 Committee considerations
The evidence
3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 9 sources, which was discussed by the committee. The evidence included 2 systematic reviews and meta-analyses, 3 cohort studies, 2 case series and 2 case reports. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.
3.2 The professional experts and the committee considered the key efficacy outcomes to be: haematoma resolution, reduction in haematoma recurrence, functional outcomes, need for further intervention and length of hospital stay.
3.3 The professional experts and the committee considered the key safety outcomes to be: bleeding, stroke, damage to structures supplied by the external carotid artery, and complications of the device used.
3.4 Patient commentary was sought but none was received.
Committee comments
3.5 This procedure is not a treatment for subdual haematoma with mass effect, but it might have a role in preventing recurrence or progression of haematomas.
3.6 The committee was informed that this procedure might have a role in people who need to continue taking anticoagulant medication and antiplatelet agents. People on anticoagulants might be at higher risk of CSDH.
3.7 There are a variety of techniques and embolisation agents used but it is uncertain which is most effective.
3.8 The committee was informed that some embolisation agents are flammable and this may pose a risk if bipolar diathermy is needed in subsequent surgery. They may also cause artefacts on subsequent imaging.
3.9 The evidence also included some people who had an asymptomatic CSDH. The committee was informed that in the UK, these people are not normally considered to need any intervention.
Tom Clutton-Brock
Chair, interventional procedures advisory committee
February 2023
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