Middle Meningeal Artery Embolization Versus Conventional Treatment of Chronic Subdural Hematomas.

Abstract

BACKGROUND\nMiddle meningeal artery (MMA) embolization is an emerging minimally invasive endovascular technique for chronic subdural hematoma (cSDH). Currently, limited literature exists on its safety and efficacy compared with conventional treatment (open-surgical-evacuation-only).\n\n\nOBJECTIVE\nTo compare MMA embolization to conventional treatment.\n\n\nMETHODS\nRetrospective analysis of patients with cSDHs treated with MMA embolization in a single center from 2018 to 2019 was performed. Comparisons were made with a historical conventional treatment cohort from 2006 to 2016. Propensity score matching analysis was used to assemble a balanced group of subjects.\n\n\nRESULTS\nA total of 357 conventionally treated cSDH and 45 with MMA embolization were included. After balancing with propensity score matching, a total of 25 pairs of cSDH were analyzed. Comparing the embolization with the conventional treatment group yielded no significant differences in complications (4%\xa0vs 4%; P\xa0>\xa0.99), clinical improvement (82.6%\xa0vs 83.3%; P\xa0=\xa0.95), cSDH recurrence (4.3%\xa0vs 21.7%; P\xa0=\xa0.08), overall re-intervention rates (12%\xa0vs 24%; P\xa0=\xa0.26), modified Rankin scale >2\xa0on last follow-up (17.4%\xa0vs 32%; P\xa0=\xa0.24), as well as mortality (0%\xa0vs 12%; P\xa0=\xa0.09). Radiographic improvement at last follow-up was significantly higher in the open surgery cohort (73.9%\xa0vs 95.6%; P\xa0=\xa0.04). However, there was a trend for lengthier last follow-up for the historical cohort (72\xa0vs 104 d; P\xa0=\xa0.07).\n\n\nCONCLUSION\nThere was a trend for lower recurrence and mortality rates in the embolization era cohort. There were significantly higher radiological improvement rates on last follow-up in the surgical only cohort era. There were no significant differences in complications and clinical improvement.