Radiology – Intervention
RCT: Adjunctive Middle Meningeal Artery Embolization Reduces Reoperation in Subdural Hematoma
24 Nov, 2024 | 13:53h | UTCBackground: Subacute and chronic subdural hematomas are common neurosurgical conditions with a high recurrence rate after surgical evacuation, affecting 8% to 20% of patients. Middle meningeal artery embolization (MMAE) is a minimally invasive procedure targeting the blood supply to these membranes. Preliminary studies suggest that adjunctive MMAE may reduce hematoma recurrence, but its impact on reoperation risk remains unclear.
Objective: To determine whether adjunctive MMAE reduces the risk of hematoma recurrence or progression leading to repeat surgery within 90 days compared to surgery alone in patients with symptomatic subacute or chronic subdural hematoma.
Methods: In this prospective, multicenter, randomized controlled trial, 400 patients aged 18 to 90 years with symptomatic subacute or chronic subdural hematoma requiring surgical evacuation were randomly assigned to receive either MMAE plus surgery (n=197) or surgery alone (n=203). The primary endpoint was hematoma recurrence or progression leading to repeat surgery within 90 days after the index treatment. The secondary endpoint was deterioration of neurologic function at 90 days, assessed using the modified Rankin Scale.
Results: Hematoma recurrence or progression requiring repeat surgery occurred in 8 patients (4.1%) in the MMAE plus surgery group versus 23 patients (11.3%) in the surgery-alone group (relative risk, 0.36; 95% CI, 0.11 to 0.80; P=0.008). Functional deterioration at 90 days was similar between groups (11.9% vs. 9.8%; risk difference, 2.1 percentage points; 95% CI, −4.8 to 8.9). Mortality at 90 days was 5.1% in the MMAE group and 3.0% in the control group. Serious adverse events related to the embolization occurred in 4 patients (2.0%), including disabling stroke in 2 patients.
Conclusions: Adjunctive MMAE combined with surgery significantly reduced the risk of hematoma recurrence or progression requiring reoperation within 90 days compared to surgery alone. However, there was no significant difference in neurologic functional deterioration, and the procedure was associated with procedural risks.
Implications for Practice: MMAE may be considered as an adjunct to surgical evacuation in patients with subacute or chronic subdural hematoma to reduce reoperation risk. Clinicians should carefully weigh the potential benefits against the risks of procedural complications, including stroke.
Study Strengths and Limitations: Strengths include the randomized controlled design and multicenter approach, enhancing generalizability. Limitations involve the open-label design, introducing potential bias since the primary endpoint was based on surgeon judgment. A substantial loss to follow-up (13.2%) could affect results, and the study was not powered to detect differences in mortality or serious adverse events.
Future Research: Further studies with larger sample sizes are needed to fully evaluate the safety and efficacy of MMAE, including long-term outcomes. Research should focus on optimizing patient selection and assessing the procedure’s impact on mortality and serious adverse events.
Review | Interventional gastroenterology in oncology.
12 Dec, 2022 | 12:46h | UTCInterventional gastroenterology in oncology – CA: A Cancer Journal for Clinicians
Single-arm Study | Extended focal ablation of localized prostate cancer with high-frequency irreversible electroporation.
11 Jul, 2022 | 11:56h | UTCExtended Focal Ablation of Localized Prostate Cancer With High-Frequency Irreversible Electroporation: A Nonrandomized Controlled Trial – JAMA Surgery (link to abstract – $ for full-text)
Commentary: Novel Focal Therapy Yields Low Rate of Serious Prostate Cancers — Trial’s 6-month rate of 6% was superior to historical control – MedPage Today (free registration required)
Commentary on Twitter
This single-arm objective performance criteria trial indicated excellent efficacy and safety profile of the second-generation high-frequency irreversible electroporation as primary treatment for localized prostate cancer. https://t.co/FheqcxJeA5
— JAMA Surgery (@JAMASurgery) July 7, 2022
Consensus Recommendations: Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities.
22 Jun, 2022 | 11:25h | UTC
Single-arm phase 2b study: MRI-guided focused ultrasound focal therapy for patients with intermediate-risk prostate cancer.
20 Jun, 2022 | 00:56h | UTCMRI-guided focused ultrasound focal therapy for patients with intermediate-risk prostate cancer: a phase 2b, multicentre study – The Lancet Oncology (link to abstract – $ for full-text)
Commentary on Twitter
In single-arm phase IIb trial of MRI-guided focused ultrasound therapy in 101 men with primary, group 2‒3 intermediate-risk untreated prostate adenocarcinomas, 88% had no evidence of group ≥2 prostate cancer in the treated area at 2 years: https://t.co/xLpqfFm8Ds #PCSM
— NatureRevClinOncol (@NatRevClinOncol) June 16, 2022
M-A: Comparison of radiofrequency ablation vs. cryoablation For T1 renal tumors.
18 May, 2022 | 10:25h | UTC
Update on image-guided thermal lung ablation: Society guidelines, therapeutic alternatives, and postablation imaging findings.
4 May, 2022 | 08:14h | UTC
Consensus Statement | Minimally-invasive treatments for benign thyroid nodules: recommendations for information to patients and referring physicians.
24 Mar, 2022 | 08:42h | UTC
Summary: German evidence-based guidelines on focal therapy in localized prostate cancer.
17 Mar, 2022 | 08:47h | UTC
RCT: Neurolytic splanchnic nerve block and pain relief, survival, and quality of life in unresectable pancreatic cancer.
30 Sep, 2021 | 10:16h | UTC
Commentary on Twitter
Neurolytic Splanchnic Nerve Block and Pain Relief, Survival, and Quality of Life in Unresectable Pancreatic Cancer: A Randomized Controlled Trial https://t.co/xa9sPAdQu1 pic.twitter.com/gi74fdDSfl
— Anesthesiology journal (@_Anesthesiology) August 30, 2021
Consensus paper: Clinical indications for image-guided interventional procedures in the musculoskeletal system—part V, knee.
23 Sep, 2021 | 09:59h | UTCSee other articles in the series: Consensus paper: Clinical indications for image-guided interventional procedures in the musculoskeletal system.
Complications of renal interventions: a pictorial review of CT findings.
21 Jul, 2021 | 10:24h | UTCComplications of renal interventions: a pictorial review of CT findings – Insights into Imaging
Systematic review: Treatments for unruptured intracranial aneurysms – There is currently insufficient good-quality evidence to support either conservative treatment or interventional treatments (microsurgical clipping or endovascular coiling)
13 May, 2021 | 05:51h | UTCTreatments for unruptured intracranial aneurysms – Cochrane Library
Summary: Treatments for unruptured intracranial aneurysms – Cochrane Library
Review: Diagnosis and treatment of unruptured intracranial aneurysms and aneurysmal subarachnoid hemorrhage
13 May, 2021 | 05:53h | UTC
M-A: Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy
18 Apr, 2021 | 21:14h | UTC
RCT: MRI-targeted biopsy safely reduces the need for biopsy in more than one-third of men at risk for prostate cancer
5 Feb, 2021 | 01:27h | UTCCommentary: Clinical trial: Using MRI for prostate cancer diagnosis equals or beats current standard – Ontario Institute for Cancer Research AND Another Win for MRI and Targeted Prostate Biopsy – MedPage Today (free registration required)
Related: MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis – New England Journal of Medicine (study and commentaries) Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta-analysis – European Urology AND Meta-Analysis: MRI plus Targeted Biopsy vs. Systematic Biopsy Alone for the Diagnosis of Prostate Cancer (studies and commentaries)