(AS2) Middle Meningeal Artery (MMA) Embolization Following Open Surgery for Chronic Subdural Hematomas Reduces Recurrence Compared to Open Surgery Alone: A Propensity Score Matched Analysis
Research Fellow/Resident Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Massachusetts, United States
Disclosure(s):
Mira Salih, MD: No financial relationships to disclose
Introduction: Middle meningeal artery embolization (MMAE) is an emerging endovascular treatment technique with proven promising results for chronic subdural hematomas (cSDH). MMAE as an adjunct to open surgery is being utilized with the goal of preventing recurrence of cSDH. However, its efficay has not been clearly demonstrated.
Methods: Patients who underwent surgical evacuation alone or MMAE along with open surgery for cSDH were identified at our institution. Two balanced groups were obtained through propensity score matching. Primary outcomes included recurrence risk and reintervention rate. Secondary outcomes included decrease in hematoma size and modified Rankin scale (mRS) at last follow up.
Results: A total of 345 cases of open surgery alone and 52 cases of open surgery plus MMAE were identified. After controlling for subjective confounders, 146 open surgery cases with drain placement and 41 MMAE following open surgery cases with drain placement were included in analysis. Before matching, rebleeding risk and reintervention rate in open surgery alone trended higher compared to open surgery plus MMAE group (14.4% vs 7.3%, p=0.18; 11.6% vs 4.9%, p=0.17 respectively). No significant difference was seen in duration of radiographic or clinical follow-ups as well as decrease in hematoma size and mRS score at last follow-up. After propensity matching, 26 pairs of cases were compared for outcomes. Recurrence rate (7.7% vs 30.8 %, p=0.038) and overall reintervention rate (3.8% vs 23.1%, p=0.049) was found to be significantly lower in the MMAE following open surgery group compared to the open surgery alone group. With one-to-many propensity score matching, 76 versus 37 cases were compared for open surgery versus MMAE following open surgery. Similarly, the open surgery group had significantly low recurrence rate (5.4% vs 19.7%, p=0.037) and overall reintervention rate (2.7% vs 14.5%, p=0.049).
Conclusion : MMAE following open surgery can lower the recurrence risk and re-intervention rate for cSDH.
