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

Huanwen Chen, Mohamed M. Salem, Marco Colasurdo, Georgios S. Sioutas, Jane Khalife, Okkes Kuybu, Kate T. Carroll, Alex Nguyen Hoang, Ammad A. Baig, Mira Salih, Mirhojjat Khorasanizadeh, Cordell Baker, Aldo Mendez Ruiz, Gustavo M. Cortez, Zack Abecassis, Juan Francisco Ruiz Rodríguez, Jason M. Davies, Sandra Narayanan, C. Michael Cawley, Howard RiinaJustin Moore, Alejandro M. Spiotta, Alexander Khalessi, Brian M. Howard, Ricardo A. Hanel, Omar Tanweer, Daniel Tonetti, Adnan H. Siddiqui, Michael Lang, Elad I. Levy, Tudor G. Jovin, Ramesh Grandhi, Visish M. Srinivasan, Michael R. Levitt, Christopher S. Ogilvy, Brian Jankowitz, Ajith J. Thomas, Bradley A. Gross, Jan Karl Burkhardt, Peter Kan

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Middle 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. Methods: cSDH 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. Results: 722 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. Conclusions: Standalone 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.

Original languageEnglish (US)
Article numberjnis-2023-020907
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - 2023

Keywords

  • Embolic
  • Hemorrhage
  • Subdural

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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