Middle meningeal artery embolization for chronic subdural hematoma: An analysis of 45 consecutive patients

Objective The authors evaluate the outcomes of 45 consecutive patients treated with MMAE in attempt to identify variables which may affect the outcome of patients treated with middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH). Methods Multivariate analysis was performed on patients who received MMAE for cSDH including age, size of cSDH, adjunct surgical drainage (ASD), presence of unilateral or bilateral collections and use of anti-coagulants. Results 20 patients underwent MMAE with planned ASD while 15 patients had MMAE only; these groups had an average reduction of 74 and 69% of cSDH respectively. Of the 15 patients who were initially treated only with MMAE, 3 (20%) required rescue craniotomy. 20 patients (57%) who had initially presented while receiving oral anticoagulants had an average of 71% reduction with ASD compared to 74% reduction in those without ASD. Patients not using anti-coagulants had 84 and 78% average reduction in size respectively. 12 patients presented with bilateral cSDH; patients who received ASD had an average reduction of 58%; those without ASD had 63%. Patients with unilateral cSDH had 85 and 83% respectively. Conclusions MMAE can be a useful alternative or adjunct to standard surgical treatment for cSDH. Our study found only 3 of 35 patients (9%) treated with this method required any further surgical intervention. No patient who received ASD had a recurrence of their cSDH. Further investigation, including prospective randomized studies would be useful to better identify which patients can benefit and variables which impact the outcome of patients undergoing MMAE.