Middle meningeal artery embolization as an adjuvant treatment to surgery for symptomatic chronic subdural hematoma: A pilot study assessing hematoma volume resorption

Abstract

Background Chronic subdural hematoma (CSDH) is a common condition requiring surgical treatment, however, recurrence occurs in 9-26% of cases. Middle meningeal artery (MMA) embolization has recently emerged as a promising treatment to prevent CSDH recurrence. Objective To investigate the effect of MMA embolization on hematoma volume resorption (HVR) after surgery in symptomatic patients. Materials and methods From April 2018 to October 2018, participants with CSDH requiring surgery were prospectively randomized in a pilot study, and received either surgical treatment alone (ST group) or surgery and adjuvant MMA embolization (ST + MMAE group). The primary outcome was HVR measured on the 3-month CT scan compared to the immediate pre-embolization CT scan. Secondary outcomes were clinical recurrence of CSDH and safety measures. Results Forty-six patients were randomized and 41 of these were present at 3-month follow-up (23 women, mean age 75.9 ± 12.5 years). Twenty-one patients received MMA embolization. At 3 months, the HVR from post-surgical level was higher in the ST + MMAE group (mean difference: 17.5 mL; 95% Confidence Interval, 3.87 to 31.16 mL; P=.015). Two participants presented a CSDH recurrence (one in each group). One patient died (ST group), and no MMA embolization-related adverse events were reported. Conclusion Addition of middle meningeal embolization to surgery led to an increase of subdural chronic hematoma resorption at 3 months. One recurrence of chronic subdural hematoma was reported in each group, and there were no treatment-related complications.