Introduction Many studies have reported the use of middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH). It is unclear whether MMAE can still be performed adequately after the dura is affected by the surgical operation. Thus, we aimed to angiographically compare MMAs in patients undergoing ‘upfront’ embolization versus those undergoing postoperative embolization.

Methods We conducted a retrospective angiographic analysis of consecutive cases in our cerebrovascular database (2019-2022) who underwent MMAE for cSDH, either as a standalone treatment (intact MMA) or after prior surgery. We assessed MMA patency through a six-point grading scale using pre-embolization angiography, where one point was given based on the presence of any amount of contrast in the corresponding MMA (figure 1). We recorded the longest diameters of craniotomies and burr holes on both axial and coronal CT slices to calculate the overall craniotomy/burr hole(s) area. We compared variables between groups and used regressions with subgroup sensitivity analyses to assess associations between area and MMA patency, and between MMA patency and outcomes.

Results Our dataset included 35 cases without and 34 cases with prior surgery. The mean age was 72 years and 20.3% were females. Among the 34 cases with prior surgery, 52.9% had undergone burr hole evacuation (median 2 burr holes, median area of 196.5 mm²) and 47.1% craniotomy (median 1 craniotomy, median area of 2684.8 mm²). Between non-surgery and surgery groups, there were no differences in MMA patency and diameter, dangerous extracranial-intracranial anastomoses, accessory meningeal artery presence, membranes on angiography, midline liquid embolic penetration, radiographic, and clinical outcomes (table 1). MMA diameter was greater in the burr hole(s) subgroup (p=0.027), and the MMA was less frequently patent in craniotomy cases (p=0.011)—specifically at the anterior-distal division (p=0.009). MMA patency was not associated with reoperation or radiographic failure on last follow-up.

Conclusion Our findings suggest that MMA patency was not affected by cSDH evacuation, except for large craniotomies affecting the anterior-distal division of MMA. However, MMA patency did not affect the outcomes of MMAE. Further, larger studies are needed to establish these findings.

• Download figure
• Open in new tab
• Download powerpoint

Abstract O-023 Figure 1

Disclosures G. Sioutas: None. S. Ajmera: None. M. Salem: None. S. Kandregula: None. J. Burkhardt: None. V. Srinivasan: None. B. Jankowitz: None.