Abstract WP214: Embolization in Chronic Subdural Hematomas

Abstract

Introduction: Middle meningeal artery embolization for chronic subdural hematomas is a promising treatment either as an adjuvant to surgical evacuation of the hematoma or as a primary treatment modality. Current randomized trials are ongoing, but there is a lack of clarity as to which embolic agent may be more effective in preventing hematoma expansion. The current study examines if there is a difference between particle and liquid embolic agents for this indication. Methods: This is a single center retrospective study from May 2019- May 2023 where 160 consecutive patients with chronic subdural hematomas were treated with embolization. In August 2021, operators at our institution switched from using NCBA or Onyx to Embospheres. We analyzed if there were differences in complication rates, requirement for surgery after embolization and changes in 90 day CT imaging with regards to resolution. A Fisher’s exact chi square test was used for binary variables and student’s t-test for continuous variables. Results: A total of 160 patients were treated with embolization and the mean age was 71± 11 years with 45 (28%) presenting with bilateral subdural hematomas. The mean maximal diameter of the collection was 16.3 ± 6.6 mm and midline shift of 4.8±4.4 mm. A total of 67 patients (42%) were treated with particles and 93(58%) with liquid embolic agents. There was one patient with facial nerve palsy in the liquid embolic group and one patient with transient vision symptoms and three with post procedural seizures in the particle embolization group. More patients treated with liquid embolic agents were on anti-platelets or anti-coagulants compared to the particle group (34% vs. 16%, p<0.01). There was no difference in requirement of surgery between the two groups (3.2% vs. 1.4%, p<0.49). Both groups had similar reduction of the maximal diameter with no difference noted at 90 days (3.9 vs. 4.4 mm, p<0.59). Conclusions: The current analysis provides preliminary evidence of the safety of both agents and no difference in outcomes noted between the two groups. A well designed future randomized trial would be helpful given the cost differences between the two types of agents.