Safety of Middle Meningeal Artery Embolization for Treatment of Chronic Subdural Hematoma: A Nationwide Analysis

Introduction: Middle meningeal artery embolization (MMAe) has burgeoned as a potential alternative or adjuvant treatment for chronic subdural hematoma (cSDH). This study evaluates the safety and short-term outcomes of MMAe patients relative to those receiving conservative management or surgical evacuation.

Methods: In this retrospective large database study, patients in the National Inpatient Sample (NIS) from 2012-2019 with a primary diagnosis of nontraumatic cSDH were categorized into four groups: no intervention, surgical evacuation only, MMAe only, and surgical evacuation plus MMAe. Cost of admission, length of stay (LOS), discharge disposition, and complications were analyzed. Multivariable analyses adjusting for patient comorbidities and propensity score matching accounting for confounding by indication were utilized. Statistical analysis was completed with R using weights to account for NIS sampling design.

Results: A total of 123,350 patients with cSDH were identified: 63,450 without intervention, 59,435 surgery only, 295 MMAe only, and 170 surgery plus MMAe. The rates of periprocedural hemorrhage or ischemia, acute kidney injury, acute respiratory failure, cardiac arrest, and sepsis were 0%. On propensity score matched analysis, MMAe was associated with increased cost relative to no-intervention patients (Beta=8,478, p< 0.001), but no difference in LOS (Beta=1.1, p=0.15). Relative to surgery, MMAe was associated with shorter LOS (Beta=-2.1, p=0.018) but no difference in cost (Beta= 6,353, p=0.2). Presence of coagulopathy was significantly associated with longer LOS (Beta=8.6, p=0.004). MMAe patients had decreased odds of adverse discharge compared to both no-intervention and surgery patients (p < 0.05) and no difference in adjusted odds of facial droop compared to no-intervention.

Conclusion : MMAe management of cSDH patients was associated with similar inpatient LOS and complication profile with modest increase in cost compared to no-intervention patients. MMAe patients’ hospitalization was 2 days fewer than their propensity-score matched surgery counterparts. This nationwide analysis supports the safety and economic efficiency of MMAe to treat cSDH.