Membrane presence in chronic subdural hematomas is associated with a reduced rate of resolution following middle meningeal artery embolization

Abstract

Background

Membrane presence is believed to drive chronic subdural hematoma (cSDH) development. The associated inflammation and angiogenesis are thought to actively contribute to the hematoma collection. This study examines the impact of membrane presence on cSDH resolution following middle meningeal artery embolization (MMA).

Methods

All patients undergoing MMA embolization for cSDH treatment from 2019 to 2024 were identified at a single tertiary care institution. The cohort was divided into two groups based on evidence of cSDH membrane presence on pre-procedural CT or MR imaging. Demographic data, baseline information, and operative characteristics were compared via univariable statistical analysis, with full cSDH resolution as the primary outcome of interest. Secondary outcomes include time to resolution, cSDH progression, length of hospital stay, and complications rate.

Results

Among 131 total embolizations performed in 105 patients, 71 (54.2 %) showed evidence of cSDH membrane presence and 60 (45.8 %) did not. The membrane group experienced a lower rate of cSDH resolution compared to the non-membrane group (p = 0.011), and presence of membranes was independently associated with a decreased likelihood of cSDH resolution (OR 0.843, 95 % CI 0.722–0.984, p = 0.032). Time to resolution, cSDH progression, length of hospital stay, and occurrence of complications were similar between the two groups.

Conclusion

Membrane presence is associated with decreased rates of cSDH resolution following MMA embolization, suggesting that membrane pathophysiology may sustain the cSDH collection despite MMA vessel occlusion. Evaluation for membrane presence on pre-procedural imaging can improve patient counseling and patient selection for MMA embolization.