Middle Meningeal Artery Embolization Does Not Confer Protection against Symptomatic Recurrence in Patients with Early Antithrombotic Therapy Following Surgery for Chronic Subdural Hematomas

Abstract

Objective: Middle meningeal artery embolization (MMAE) has emerged as a promising treatment, both as an adjunct to surgery and as a primary treatment for chronic subdural hematoma (cSDH). Here, we evaluate the efficacy of MMAE following surgery in reducing the likelihood of reoperation in patients requiring early introduction of antithrombotics.

Methods: From our prospectively collected registry of patients with cSDH, we identified patients treated with surgical evacuation, either in combination with or without MMAE. Patients were included if they had a clinical indication requiring early antithrombotics within 7 days of surgery. The primary outcome was the rate of reoperation. The secondary outcomes included recurrence in midline shift or changes in cSDH width based on imaging findings.

Results: Among 43 patients (53 total cSDHs) who met the inclusion criteria for the study, the median age was 71 years, 13% were female, the mean SDH thickness was 17.9 mm, and the most commonly used postoperative antithrombotic was aspirin. Sixteen cSDHs in 13 patients were treated with MMAE + surgery, while 37 cSDHs in 30 patients were treated with surgery alone. There was no difference in reoperation rates between the 2 groups (8.1% vs. 0%, surgery alone vs. surgery + MMAE, p = 0.55), nor in the rate of recurrence (24.3% vs. 12.5%, surgery alone vs. surgery + MMAE, p = 0.47).

Conclusion: In this single-center cohort study, we found no clear benefit in reduced rates of reoperation or recurrence for adjunctive MMAE in patients with cSDH treated with surgical evaluation. Despite this, encouraging trends were observed in the MMAE + surgery group.