Background Chronic subdural hematomas (cSDH) are associated with significant morbidity and high rates of recurrence, and effective management is essential to reducing the disease burden. Middle meningeal artery (MMA) embolization is a minimally invasive treatment strategy which is growing in popularity. We sought to evaluate whether hematoma volume and midline shift were reduced in the immediate post-operative window (<24h) following embolization.

Methods We performed a retrospective analysis of 81 unique patients with 98 chronic subdural hematomas managed via MMA embolization. SDH volumes and midline shift were quantified through image segmentation pre- and post-operatively (24-hour post-procedure) through computed tomography (CT) scans. Other demographic, clinical and operative parameters were abstracted from the medical record in a subset of patients for multivariate analysis. Paired t-tests were used to determine significant reduction in midline shift and SDH volume. Multivariate analysis was performed using logistic and linear regression for percent improvement from baseline volume.

Results Across 81 patients and 98 cSDHs, the mean initial SDH volume was 66.54 mL (SD: 34.67 mL), with the mean midline shift as 3.79 mm (SD: 2.85 mm). There was a significant mean reduction in SDH volume post-operatively (12.1 mL (95% CI: 9.32 - 14.27 mL), p < 0.001). There was also a significant mean reduction in midline shift (0.8 mm (95% CI: 0.24 - 1.36 mm), p = 0.006). 22% of patients had a reduction of over 30% in the immediate post-operative period. A multivariate analysis of 36 patients was performed. There were no significant parameters observed influencing degree of reduction.

Discussion MMA embolization is a safe, and effective approach for the management of cSDH patients. We show a significant reduction of hematoma volume and reduction of midline shift even in the acute post-operative period. Larger studies, randomized trials, and longer-term studies are needed to confirm these findings.

Disclosures J. Catapano: None. S. Hanalioglu,: None. D. Farhadi: None. O. Tunc: None. A. Naik: None. E. Winkler: None. V. Srinivasan: None. S. Koester: None. M. Lawton: None. A. Jadhav: None. A. Ducruet: None. F. Albuquerque: None.