Article Text
Abstract
Introduction/Purpose Middle meningeal artery embolization (MMAe) is a promising treatment modality for chronic subdural hematoma (cSDH). The best practices and treatment protocols for cSDH continue to evolve with the advent of MMAe. The objective of this study was to compare MMAe outcomes between 75 µm microspheres (Embozene) and ethylene vinyl alcohol (Onyx) at the only adult Level 1 Trauma Center in Arkansas.
Materials and Methods A retrospective review was conducted of all patients who have undergone MMAe for cSDH at one tertiary care center. Inclusion criteria were defined as: age >18, MMA embolization for cSDH (with or without acute/subacute components), and MMA embolization utilizing a single embolic agent, either Embozene or Onyx. Primary outcomes included failure of embolization and need for unplanned surgical evacuation; failure of embolization was defined as increase in SDH size, new or worsening symptoms ipsilateral to the SDH, or need for unplanned surgical evacuation. Secondary outcomes included the following: SDH thickness at early follow-up, midline shift (MLS) at early follow-up, and modified Rankin scale (mRS) at latest follow-up. Early follow-up was defined as within 2 to 8 weeks of embolization. Details of statistical analyses may be found in each respective table.
Results A total of 28 MMA embolizations met inclusion criteria, of which 21 (75%) received Embozene and 7 (25%) received Onyx. The rate of acute or subacute on cSDH was 11/21 (52.3%) in the Embozene group versus 5/7 (71.4%) the Onyx group. No significant difference between failure of embolization or need for unplanned surgical evacuation were observed (table 1). Mean SDH thickness, in mm, at early follow-up was 6.9 ± 4.7 for the Embozene group and 8.9 ± 6.3 for the Onyx group, with no significant difference found between the two groups (table 2).
Conclusion In this single-center analysis of MMAe outcomes comparing Embozene and Onyx, no significant difference was found between failure of embolization and need for unplanned surgical evacuation in the post-embolization period. Secondary outcomes, including SDH thickness at early follow-up, midline shift at early follow-up, and modified Rankin scale at latest follow-up demonstrated no significant difference between the two embolic agents. Further, Embozene and Onyx demonstrate comparable clinical outcomes in the setting of MMAe. Limitations of this study include the small sample size, unequal Embozene and Onyx group sizes, and lack of long-term follow-up.
Disclosures A. McClanahan: None. G. Vilanilam: None. R. Jadhav: None. M. Kamran: None. S. Patro: None.