Standalone middle meningeal artery embolization versus middle meningeal artery embolization with concurrent surgical evacuation for chronic subdural hematomas: a multicenter propensity score matched analysis of clinical and radiographic outcomes

Author:

Chen HuanwenORCID,Salem Mohamed MORCID,Colasurdo MarcoORCID,Sioutas Georgios SORCID,Khalife Jane,Kuybu Okkes,Carroll Kate T,Hoang Alex Nguyen,Baig Ammad AORCID,Salih Mira,Khorasanizadeh Mirhojjat,Baker Cordell,Mendez Ruiz Aldo,Cortez Gustavo M,Abecassis Zack,Ruiz Rodríguez Juan Francisco,Davies Jason M,Narayanan SandraORCID,Cawley C Michael,Riina Howard,Moore Justin,Spiotta Alejandro MORCID,Khalessi Alexander,Howard Brian MORCID,Hanel Ricardo A,Tanweer Omar,Tonetti Daniel,Siddiqui Adnan HORCID,Lang MichaelORCID,Levy Elad I,Jovin Tudor G,Grandhi RameshORCID,Srinivasan Visish M,Levitt Michael RORCID,Ogilvy Christopher SORCID,Jankowitz Brian,Thomas Ajith J,Gross Bradley AORCID,Burkhardt Jan Karl,Kan PeterORCID

Abstract

BackgroundMiddle meningeal artery embolization (MMAE) has emerged as a promising therapy for chronic subdural hematomas (cSDHs). The efficacy of standalone MMAE compared with MMAE with concurrent surgery is largely unknown.MethodscSDH patients who underwent successful MMAE from 14 high volume centers with at least 30 days of follow-up were included. Clinical and radiographic variables were recorded and used to perform propensity score matching (PSM) of patients treated with standalone MMAE or MMAE with concurrent surgery. Multivariable logistic regression models were used for additional covariate adjustments. The primary outcome was recurrence requiring surgical rescue, and the secondary outcome was radiographic failure defined as <50% reduction of cSDH thickness.Results722 MMAE procedures in 588 cSDH patients were identified. After PSM, 230 MMAE procedures remained (115 in each group). Median age was 73 years, 22.6% of patients were receiving anticoagulation medication, and 47.9% had no preoperative functional disability. Median midline shift was 4 mm and cSDH thickness was 16 mm, representing modestly sized cSDHs. Standalone MMAE and MMAE with surgery resulted in similar rates of surgical rescue (7.8% vs 13.0%, respectively, P=0.28; adjusted OR (aOR 0.73 (95% CI 0.20 to 2.40), P=0.60) and radiographic failure (15.5% vs 13.7%, respectively, P=0.84; aOR 1.08 (95% CI 0.37 to 2.19), P=0.88) with a median follow-up duration of 105 days. These results were similar across subgroup analyses and follow-up durations.ConclusionsStandalone MMAE led to similar and durable clinical and radiographic outcomes as MMAE combined with surgery in select patients with moderately sized cSDHs and mild clinical disease.

Publisher

BMJ

Subject

Neurology (clinical),General Medicine,Surgery

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