(AS2) Dexamethasone in Patients Undergoing Primary Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Propensity-matched Study in the Trinetx Analytics Network

Introduction: Chronic subdural hematoma (cSDH) is a common neurosurgical disorder prevalent among the elderly. While the effect of dexamethasone on outcomes in patients with cSDH undergoing surgical evacuation has been studied, its interaction with middle meningeal artery (MMA) embolization is still unknown.

Methods: Utilizing the TriNetX Analytics Network, we queried 662 cases from 70 health care organizations. We included patients ≥18 years old with cSDH (ICD-10:I62.03, I62.00) who underwent MMA embolization within 1 month of diagnosis (CPT:61624, 61626), with or without taking dexamethasone any time after diagnosis until 2 weeks after embolization, for any reason, any dose. Cases with surgical evacuation after diagnosis until 2 weeks after embolization were excluded. Other embolization indications were excluded. Analyses of 3-year outcomes were performed after propensity score matching, controlling for baseline characteristics, medications, lab values, comorbidities, infections and ventilator use, care provider, and wheelchair dependence.

Results: A total of 662 patients were available for initial comparisons. The dexamethasone cohort consisted of 215 patients with mean age 68.7±14.3 and 36.3% females. The no dexamethasone cohort consisted of 447 patients with mean age 72.8±13.2 and 28.2% females. A total of 189 patients were included in each cohort after propensity matching. Mortality (14.3% vs 18.0%, p=0.3277), functional/provider dependence (8.5% vs 10.1%, p=0.5945) and headaches (19.0% vs 18.5%, p=0.8952) were similar between the two cohorts. All other outcomes occurred in a maximum of 10 patients and were reported as 0 or 10, precluding meaningful comparisons. Blindness and low vision and facial weakness occurred in 1–10 (0.5–5.3%) patients in each cohort. Repeat surgical evacuation occurred in 1–10 (0.5–5.3%) patients only in the dexamethasone cohort.

Conclusion : This national database analysis of 378 propensity-matched patients provides evidence that dexamethasone administration along with primary MMA embolization for cSDH has no effect on mortality, headaches, or functional/provider dependence.