Article Text
Abstract
Introduction Middle meningeal arterial (MMA) embolization has recently emerged as a technique for chronic subdural hematoma (cSDH) management, serving as an adjunct to traditional surgical evacuation or as a monotherapy in non-operative cSDH. Performance of these additional therapies is an important consideration as they may contribute to increased cost of care and utilization of resources, which is of special interest in lower resource settings. In this study, we report on our institution’s use of MMA embolization in a large urban population, stratifying the cohort depending on if any separate treatment was performed in addition to MMA embolization.
Methods All patients presenting to our center from August 2019 to February 2024 for MMA embolization for cSDH were eligible for inclusion in this analysis. Patients were prospectively enrolled, and data was retrospectively abstracted through chart review, including past medical history, presenting symptoms, laterality of treatment, recurrence, and mortality. Subsequent analysis was performed with two-tailed student’s t-test and statistical significance was set at p < 0.05.
Results In total, 138 patients underwent MMA embolization for SDH in this single-center retrospective study. The average age of this cohort was 71.6 years, with a majority of male patients (73.2%). 40.6% of the cohort was asymptomatic at presentation with 66.7% of the cohort having a prior diagnosis of hypertension. Additional treatments, such as a Subdural Evacuating Port System Procedure or surgical evacuation, were performed in addition to embolization in 52.2% of the cohort. There were no statistically significant differences of repeat treatment (10.6% vs 6.9%, p = 0.449), recurrence of SDH (12.1% vs 5.6%, p = 0.17), or death at last clinical follow-up (9.1% vs 12.5%, p = 0.52).
Discussion In conclusion, this study presents insights on the comprehensive management of patients with cSDH. The findings from this suggest that MMA embolization, whether used as an adjunct or monotherapy in SDH treatment, is associated with comparable rates of retreatment, SDH recurrence, and mortality. These results are especially critical in low-resource settings and underscore the importance of further investigation into the efficacy of MMA embolization as a potential comprehensive treatment option.
Disclosures R. Kalagara: None. A. Devarajan: None. A. Rao: None. B. Philbrick: None. A. Bhimani: None. D. Goldman: None. K. Perlman: None. J. Fifi: None. H. Shoirah: None. S. Majidi: None. C. Kellner: None. J. Mocco: None. T. Shigematsu: None.