Abstract Number ‐ 106: Particle Versus Liquid Embolic Materials in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Abstract

Introduction Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diagnoses with a high recurrence rate in the aging population. The primary pathologic process is repeated micro bleeding from fragile neo‐vessels supplied by peripheral branches of the middle meningeal artery (MMA). MMA embolization is an efficacious minimally invasive neuroendovascular technique for the management of chronic subdural hematoma. It has demonstrated reduced incidence of re‐bleeding and recurrence of cSDH in elderly patients. Particle and liquid embolic materials are commonly used to devascularize the MMA however studies comparing the safety and outcomes between these two materials are limited. Our objective was to perform a descriptive analysis to investigate differences and outcomes among two most frequently employed materials for MMA embolization. Methods We performed a single center retrospective review of patients ≥ 18 years who had MMA embolization for cSDH between July 2020 and May 2022. The primary safety, radiation dosage, fluoroscopy time, radiographic and clinical outcomes were compared between particle and liquid embolization. A descriptive analysis for continuous and categorical variables was performed using SAS 9.4 version. Results In a cohort of 116, 48 (41.38%) were treated with liquid embolic material and 68 (58.62%) were treated with particle. The median age of the cohort was 73 years in particle group and 73.5 years in liquid embolic group. There was no significant difference in radiation dose or duration among both groups. There was no reported mortality associated to procedure. One patient experienced non‐disabling ischemic stroke in the particle group. Based on imaging follow‐up, three patients in particle group and one in liquid embolic group had asymptomatic recurrence. One patient in each group had symptomatic recurrence requiring hematoma evacuation. Index median size of hematoma was 12 mm in particle group and 11 mm in liquid embolic group. At approximately one month follow up, the median size of hematoma reduced to 6 mm in both groups. Conclusions Our series demonstrates that liquid embolic and particle embolization are equally safe and effective among patients undergoing MMA embolization for management of cSDH.