870 Middle Meningeal Artery Embolization Does Not Confer Protection Against Symptomatic Recurrence in Patients With Early Anticoagulation Following Surgery for Chronic Subdural Hematomas

Abstract

INTRODUCTION: Chronic subdural hematoma (cSDH) is a prevalent condition that carries a significant burden. Middle meningeal artery embolization (MMAE) has emerged as a promising treatment both as an adjunct to surgery and as a primary treatment. A number of patients suffering from cSDH have concurrent comorbidities necessitating early introduction of antithrombotic medications. The question of whether adding MMAE to surgically evacuated cSDH confers protection against recurrence in this subgroup of patients is unclear. METHODS: This a single center study. Patients in the surgery + MMAE cohort were identified from a prospectively collected MMAE registry and compared to a historical surgery cohort presenting over a 2-year period prior to the introduction of MMAE in our institution. Included patients had evacuation of cSDH with either burrholes or craniotomy. Patients were included if they had a clinical indication requiring early antithrombotics within 5 days of surgery. The primary outcome was reoperation. RESULTS: A total of 16 cSDHs in 13 patients (MMAE + surgery) and 32 cSDHs in 27 patients (surgery) met the inclusion criteria. No significant differences of baseline characteristics was identified. There was a total of 2 recurrences in the group that underwent MMAE with no reoperation. In the group of surgery alone, there was 4 recurrence and 3 reoperations. The rate of reoperation however was not significantly different in the two cohort neither was the rate of recurrence. (p = 0.54 and 0.7 respectively). CONCLUSIONS: This study analyzed a specific subset of patients requiring ultra-early administration of antithrombotic medications. While MMAE is gaining momentum as an adjunct to surgery, or even as sole treatment, it is unclear whether addition of MMAE to surgery confers any protection against recurrence or surgery in this particular subset.