Middle Meningeal Artery Embolization After Craniotomy versus Burr Holes: Does Type of Surgery Influence Outcomes?

Introduction: Middle meningeal artery embolization (MMAE) is increasingly utilized as an adjunct to open surgery to prevent recurrence of cSDH. However, there is no data comparing outcomes of MMAE after craniotomy versus burr holes. Our study aimed to compare the outcomes of MMAE following craniotomy versus burr holes.

Methods: Patients who underwent MMAE following open surgery were identified from our institutional database. Based on the difference in open surgical modality patients were divided into MMAE following craniotomy versus MMAE following burr holes. Outcome data on recurrence and reintervention rate, decrease in hematoma size and modified Rankin scale (mRS) at last follow up were collected for comparison.

Results: In total 23 patients had MMAE following craniotomy while 26 cases had MMAE after burr holes. No significant difference was found in mean age between these two groups (73.9 ± 10.7 vs 75.2 ± 11.7; p= 0.68). 19.2% of patients were female in the burr hole group while 43.5% were female in the craniotomy group. Post-operatively, 3 patients (13%) had seizures in the MMAE following craniotomy group, while no seizures were observed in patients with burr holes plus MMAE (p=0.096). No significant difference was seen in duration of radiographic or clinical follow ups as well as mRS score at last follow up (P>0.05). Two patients (8.7%) had reintervention for recurrence of subdural hematoma in the MMAE following craniotomy group while only 1 patient (3.85%) had reintervention after recurrence in the burr hole group (0.59).

Conclusion : MMAE following craniotomy and MMAE after burr holes have similar efficacy, however, combination of MMAE and burr holes had less post-procedure complications. This may relate to the initial complexity of the cSDH with loculated lesions requiring more extensive surgery.