Middle Meningeal Artery Embolization Versus Conventional Treatment of Chronic Subdural Hematomas

BACKGROUND: Middle meningeal artery (MMA) embolization is an emerging minimally invasive endovascular technique for chronic subdural hematoma(cSDH). Currently, limited literature exists on its safety and efficacy compared with conventional treatment (opensurgical-evacuation-only). OBJECTIVE: To compare MMA embolization to conventional treatment. METHODS: Retrospective analysis of patients with cSDHs treated withMMA embolization in a single center from 2018 to 2019 was performed. Comparisons were made with a historical conventional treatment cohort from 2006 to 2016. Propensity score matching analysis was used to assemble a balanced group of subjects. RESULTS: A total of 357 conventionally treated cSDH and 45 with MMA embolization were included. After balancing with propensity score matching, a total of 25 pairs of cSDH were analyzed. Comparing the embolization with the conventional treatment group yielded no significant differences in complications (4% vs 4%; P>.99), clinical improvement (82.6% vs 83.3%; P=.95), cSDH recurrence (4.3% vs 21.7%; P=.08), overall re-intervention rates (12% vs 24%; P=.26), modified Rankin scale >2 on last follow-up (17.4% vs 32%; P=.24), as well as mortality (0% vs 12%; P=.09). Radiographic improvement at last follow-up was significantly higher in the open surgery cohort (73.9% vs 95.6%; P=.04). However, there was a trend for lengthier last follow-up for the historical cohort (72 vs 104 d; P=.07). CONCLUSION: There was a trend for lower recurrence and mortality rates in the embolization era cohort. There were significantly higher radiological improvement rates on last follow-up in the surgical only cohort era. There were no significant differences in complications and clinical improvement.