Abstract TP38: Efficacy of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Abstract

Background: Symptomatic chronic subdural hematoma (SDH) is treated with surgical evacuation. SDH has a high incidence of recurrence despite evacuation, reported between 2% and 37%. Multiple case reports and case series demonstrate embolization of the Middle Meningeal artery (MMA) for the treatment of chronic SDH to be an adjunct treatment and a possible alternative to surgical evacuation. Method: Retrospective analysis of patients with chronic SDH who underwent MMA embolization at our community based, Comprehensive Stroke Center between April and August 2019 was done. MMA embolization was performed using 100-300 or 300-500 μm Embospheres. Results: 18 patients presented with chronic SDH, 55% female. Mean age and modified Rankin score was 70 (range: 48-95 years) and 1 (range: 0-3), respectively. 17 patients (94%) required a total of 20 MMA embolizations. 83% had unilateral MMA embolization and 17% had bilateral MMA embolizations. 100-300 μm Embospheres were used for the MMA embolization in 82% of the patients and 300-500 μm Embospheres in 18% of the patients. 33% had Burr hole prior to the procedure. 5% ( n= 1) patient had Burr hole evacuation after embolization due to Neurosurgeon preference, not neurological deterioration. 56 % patient received treatment to resume anticoagulation/antiplatelet and 44% received prophylactic embolization to prevent reaccumulation after Burr hole evacuation. Mean size of maximum diameter of SDH was 16.9 mm and 4.6 mm of midline shift on admission CT. Mean SDH size and midline shift at discharge was 13 mm and 2.27 respectively. 50% patients had 1 month follow up CT with mean SDH size was 8.2 mm (in comparison to 19.7 in these patients). 17 % (n=3) patients had complete resolution on 3 month follow up. The one patient treated with 300-500 μm Embospheres had an acute on chronic asymptomatic SDH on 1 month follow up CT, requiring accessory meningeal artery embolization with 100-300 μm Embospheres ultimately resulting complete resolution of the SDH at 1 month post embolization. Conclusion: Despite limited data available, Middle Meningeal artery embolization using 100-300 μm Embospheres leads to reproducible results to prevent recurrence of chronic subdural hematoma. A large randomized controlled study is needed to verify our results.