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• Posted November 21, 2024

There May Be a Better Way to Treat Hematoma Brain Bleeds

After a hit to the head or a fall, people, especially seniors, can develop a dangerous pooling of blood and fluid between the brain's surface and it's protective covering, the dura.

These "subdural hematomas" typically require surgery to fix, but a new study suggests a better approach, one that makes sure repeat surgeries aren't required.

That's important, because “even after you remove the blood, it can come back and require more surgery," explained study co-lead author Dr. Jared Knopman.

"This is particularly challenging for older patients, who are the most prevalent group suffering from chronic subdural hematomas,” he added. Knopman directs cerebrovascular surgery and interventional neuroradiology at Weill Cornell Medicine in New York City.

The new technique, outlined in a study published Nov. 21 in the New England Journal of Medicine, combines standard hematoma surgery with an embolization (blocking) of the brain's middle meningeal artery.

In this procedure, a compound that essentially "glues together" and blocks this artery renders repeat surgeries unnecessary.

The "liquid embolic agent" used as the glue in this embolization technique is called Onyx and is made by Medtronic, which funded the new trial.

The embolization is minimally invasive: Doctors thread a small catheter containing Onyx into the middle meningeal artery via vessels in the wrist or groin.

Researchers found the combo of surgery plus embolization reduced the need for repeat surgeries by nearly threefold.

The study involved 400 patients with subdural hematomas treated at 39 medical centers. The patients, who averaged 72 years of age, got either standard hematoma surgery (203 patients) or surgery plus Onyx embolization.

While 11.3% of people who got surgery alone required a second surgery within three months of their first procedure, that was true for only 4% of those who got the combo approach.

Sealing off the middle meningeal artery using Onyx was key to improving outcomes, Knopman said in a Weill Cornell news release.

"In addition to demonstrating the role that the middle meningeal artery plays in the formation and recurrence of subdural hematomas, we have discovered an entirely new facet about the brain that has gone unknown and untreated for decades,” he explained.

Dr. Jason Davies, of the University at Buffalo (UB), co-led the study with Knopman. Speaking in a university news release, he stressed that preventing hematoma re-bleeds is especially tough when an older patient is already on a blood thinner, as is often the case.

“A patient with a chronic subdural hematoma who is on a blood thinner presents an even more complicated picture,” said Davies, associate professor of neurosurgery at UB. “If you are on a blood thinner, once you start bleeding, you’re not going to stop.”

Up to 1 in 5 hematomas will become chronic and require multiple surgeries, which of course come with their own costs and risks, the researchers said.

Left untreated, “these hematomas often get bigger over time and can be very irritating to the brain, exerting more pressure and preventing the brain from functioning properly,” Davies noted.

The new combo approach could be game-changing, he believes.

“We are changing the way that we are treating this very common disease,” Davies said. “We are changing subdural hematoma from being a disease that commonly requires multiple surgeries to a disease that can be better treated with a simple, minimally invasive procedure that produces better outcomes.”

More information

Find out more about subdural hematomas at the National Library of Medicine.

SOURCES: University at Buffalo and Weill Cornell Medicine, news releases, Nov. 21, 2024