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Purpose <p>to comprehensively and hierarchically assess risk factors for recurrence requiring reoperation (RrR) in chronic subdural hematoma (cSDH) in the era of middle meningeal artery embolization (MMAE).</p> Methods <p>Patients treated for a cSDH from January 2019 to October 2024 at Fondazione Gemelli research hospital were considered for inclusion. Clinical, coagulation, radiological, and treatment factors were recorded. MMAE was performed systematically from October 2022, using polyvinyl alcohol (PVA) particles injected directly from the main trunk of MMA.</p> <p>The dataset comprised 45 quantitative and qualitative variables for each cSDH. Variables showing statistical significance (p-value &lt; 0.05) were selected as covariates in two supervised learning frameworks to predict the RrR (outcome, <i>Y</i>): (<i>i</i>) Classification and Regression Tree (CART) and (<i>ii</i>) Random Forest (RF) classifier.</p> Results <p>500 patients were eligible and 233 were included, resulting in 283 treated cSDHs (mean follow-up: 119&#xa0;days); 129 underwent adjuvant MMAE. 50 cSDH had a RrR (mean time to recurrence: 47&#xa0;days), of which 41 (82%) in the non-embolized group and 9 (18%) in the embolized group (p-value &lt; 0.001). Adjuvant embolization was the strongest factor associated with RrR, significantly reducing the risk for reintervention. Markwalder grading scale, preoperative cSDH volume, and platelet count (PLT) are strong predictors in non-embolized patients. A critical PLT cut-off of 229 × 10<sup>9</sup>/L strongly impacts RrR risk for substantial cSDH volumes.</p> Conclusions <p>The present results support the routine use of MMAE and the correction of PLT in relation to cSDH volume.</p>

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A visual mining analysis of middle meningeal embolization and other factors associated with recurrence requiring re-operation in subdural hematomas: a single-center series

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月20日

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  • Marco Battistelli,
  • Marika Vezzoli,
  • Iacopo Valente,
  • Massimo Benenati,
  • Giuseppe Garignano,
  • Andrea Alexandre,
  • Ludovico Agostini,
  • Samuele Santi,
  • Ottavia Giovinazzo,
  • Leonardo Nardini,
  • Federico Costa,
  • Giorgio Quintino D’Alessandris,
  • Manuela D’Ercole,
  • Alessandro Izzo,
  • Alessandro Rapisarda,
  • Francesco Signorelli,
  • Nicola Montano,
  • Simona Gaudino,
  • Alessandro Olivi,
  • Alessandro Pedicelli,
  • Filippo Maria Polli,
  • Francesco Doglietto

摘要

Purpose

to comprehensively and hierarchically assess risk factors for recurrence requiring reoperation (RrR) in chronic subdural hematoma (cSDH) in the era of middle meningeal artery embolization (MMAE).

Methods

Patients treated for a cSDH from January 2019 to October 2024 at Fondazione Gemelli research hospital were considered for inclusion. Clinical, coagulation, radiological, and treatment factors were recorded. MMAE was performed systematically from October 2022, using polyvinyl alcohol (PVA) particles injected directly from the main trunk of MMA.

The dataset comprised 45 quantitative and qualitative variables for each cSDH. Variables showing statistical significance (p-value < 0.05) were selected as covariates in two supervised learning frameworks to predict the RrR (outcome, Y): (i) Classification and Regression Tree (CART) and (ii) Random Forest (RF) classifier.

Results

500 patients were eligible and 233 were included, resulting in 283 treated cSDHs (mean follow-up: 119 days); 129 underwent adjuvant MMAE. 50 cSDH had a RrR (mean time to recurrence: 47 days), of which 41 (82%) in the non-embolized group and 9 (18%) in the embolized group (p-value < 0.001). Adjuvant embolization was the strongest factor associated with RrR, significantly reducing the risk for reintervention. Markwalder grading scale, preoperative cSDH volume, and platelet count (PLT) are strong predictors in non-embolized patients. A critical PLT cut-off of 229 × 109/L strongly impacts RrR risk for substantial cSDH volumes.

Conclusions

The present results support the routine use of MMAE and the correction of PLT in relation to cSDH volume.