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E-158 Particles or onyx? Comparing middle meningeal artery embolization resolution rates for chronic subdural hematomas at a large teaching hospital
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  1. J Graves1,
  2. J Ehlert1,
  3. S Manoochehri2,
  4. B Root2
  1. 1Neurosurgery, Drexel University College of Medicine at Tower Health, Wyomissing, PA
  2. 2Neurosurgery, Tower Health at Reading Hospital, West Reading, PA

Abstract

Introduction/Purpose Chronic subdural hematomas are frequently managed by middle meningeal artery (MMA) embolization with or without burr hole evacuation. There is limited research comparing the resolution rates of chronic subdural hematomas in onyx versus particle embolization.

Materials and Methods A retrospective cohort study was conducted on 83 patient charts between 2020 and 2023. Inclusion criteria required successful completion of at least one MMA embolization and at least one follow-up CT between 3 weeks and 6 months post-procedure. Hematoma resolution was determined by resorption of greater than 70% compared to pre-procedure CT. Chi-square analysis was performed using Microsoft Excel with a 95% confidence interval.

Results 63 patients were included, with 15 undergoing bilateral procedures, for a total of 78 MMA embolizations. There were 59 embolizations utilizing onyx, and 19 utilizing particles. The cohort consisted of 47 males and 16 females with a mean age of 75 years. 56 patients identified as White/Caucasian, five as Hispanic, four as Black, and three as other. Of the 59 onyx embolizations, 25 (42.4%) had resolution within six months. Comparatively, nine of the 19 particle embolizations (47.4%) had resolution at six months. There was no significant difference in hematoma resolution between onyx and particle embolization (P = 0.703). 15 of the 63 patients underwent burr hole evacuation preceding or within days of the MMA embolization (18 total surgical interventions when including bilateral procedures). In this subgroup, there was no significant difference in hematoma resolution between onyx and particle embolization (P = 0.168). There were two patients who underwent burr hole evacuation one month after the MMA embolization (one with onyx and one with particles) due to persistent clinical symptoms and less than 70% resolution. These two instances were the only subdural hematoma recurrences out of the 78 MMA embolizations. 60 MMA embolizations were performed without accompanying burr hole evacuation. There was no significant difference in hematoma resolution between onyx and particle embolization alone (P = 0.698).

Conclusion There is no significant difference in chronic subdural hematoma resolution rates for onyx versus particle MMA embolization with or without coinciding burr hole evacuation.

Disclosures J. Graves: None. J. Ehlert: None. S. Manoochehri: None. B. Root: None.

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