Stand-Alone Middle Meningeal Artery Embolization for Treatment of Giant Chronic Subdural Hematoma in Elderly Frail Patients: A Case Series

Abstract

ABSTRACT BACKGROUND Previous case series have demonstrated safety and efficacy of middle meningeal artery (MMA) embolization as both adjuvant and stand-alone treatment of chronic subdural hematoma (cSDH). The safety and efficacy of stand-alone MMA embolization for treatment of giant (>150 ml) cSDH in specifically elderly, frail patients is not well studied. OBJECTIVE To evaluate the safety and efficacy of stand-alone MMA embolization for treatment of giant cSDH in elderly, frail patients in whom traditional surgical intervention was deemed high risk. METHODS We reviewed the records of consecutive patients referred for MMA embolization and identified patients ≥ 75 yr with modified Frailty Index (mFI) ≥ 2 who underwent stand-alone MMA embolization for cSDH treatment with at least one follow-up imaging study. RESULTS A total of 42 patients were referred for MMA embolization with 5 patients meeting inclusion age and frailty criteria. The average age was 82.2 ± 6.8 yr. The median mFI was 3.0 (interquartile range (IQR) 2-4). Four patients were either on aspirin or thrombocytopenic. The average initial cSDH volume was 187.8 ± 31 ml with average initial midline shift of 8.0 ± 2.1 mm. The average length of stay was 4 ± 1.1 d. The average cSDH volume decrease on follow-up imaging was 68.5% ± 11.9%. Follow-up average midline shift decreased by 70% to 2.4 ± 1.4 mm. There were no peri-procedural or in-hospital complications. CONCLUSION In frail, elderly patients with giant cSDH, stand-alone MMA embolization was effective in reducing cSDH volume and improving presenting symptoms without complications.