Effect of Early Versus Delayed Middle Meningeal Artery Embolization on Clinical Outcomes in Chronic Subdural Hematoma: A Propensity Score-Matched Cohort Study

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-09-01 DOI:10.1016/j.clineuro.2025.109126

Hamza Adel Salim , Orabi Hajjeh , Huanwen Chen , Muhammed Amir Essibayi , Nimer Adeeb , Ahmed Msherghi , Adam A. Dmytriw , Marco Colasurdo , Ajay Malhotra , Vivek S Yedavalli , Dheeraj Gandhi , Max Wintermark , Dhairya A. Lakhani

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引用次数: 0

Abstract

Background

Chronic subdural hematoma (cSDH) is a common neurosurgical condition with a high recurrence rate following surgical evacuation. Middle meningeal artery embolization (MMAE) has emerged as an adjunctive or standalone treatment, but the optimal timing of embolization remains unclear. We evaluated whether early MMAE (≤2 days) versus delayed MMAE (3-7 days) is associated with improved clinical outcomes.

Methods

In this retrospective, multicenter cohort study, we identified adult patients with cSDH who underwent MMAE using de-identified real-world patient data from the TriNetX platform. Patients were stratified into early versus delayed MMAE groups, defined relative to the date of surgery (surgical cohort) or diagnosis (non-surgical cohort). Propensity score matching (1:1) was performed based on demographics and comorbidities. The primary outcome was all-cause mortality and secondary outcomes included repeat surgical evacuation (for surgical cohort) and need for surgical evacuation (for non-surgical cohort) at 6-months.

Results

In the matched surgical cohort (n=326), early MMAE was associated with a lower, but not statistically significant, rate of mortality compared to delayed MMAE (6.1% vs. 11.0%; OR, 0.527; 95% CI, 0.235 to 1.178; P=0.114). Similar rates were observed for repeat surgery for both groups. In the matched non-surgical cohort (n=450), early MMAE was not associated with significant differences in mortality or need for surgery.

Conclusions

Among patients with cSDH, early MMAE was associated with numerically lower rates of mortality in the surgical cohort. These findings support further investigation of early MMAE as a potential strategy to improve outcomes in surgical cSDH cases.

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早期与延迟脑膜中动脉栓塞对慢性硬膜下血肿临床结果的影响：一项倾向评分匹配的队列研究

背景：慢性硬膜下血肿（cSDH）是一种常见的神经外科疾病，术后复发率高。脑膜中动脉栓塞（MMAE）已成为一种辅助或独立的治疗方法，但栓塞的最佳时机尚不清楚。我们评估了早期MMAE（≤2天）与延迟MMAE（3-7天）是否与改善临床结果相关。方法在这项回顾性、多中心队列研究中，我们使用来自TriNetX平台的去识别真实世界患者数据，确定了接受MMAE的成年cSDH患者。根据手术日期（手术队列）或诊断日期（非手术队列），将患者分为早期和延迟MMAE组。根据人口统计学和合并症进行倾向评分匹配（1:1）。主要结局是全因死亡率，次要结局包括6个月时重复手术撤离（手术组）和需要手术撤离（非手术组）。结果在匹配的手术队列中（n=326），与延迟MMAE相比，早期MMAE与较低但无统计学意义的死亡率相关（6.1%对11.0%；OR, 0.527; 95% CI, 0.235 ~ 1.178； P=0.114）。两组重复手术的发生率相似。在匹配的非手术队列中（n=450），早期MMAE与死亡率或手术需求的显着差异无关。结论：在cSDH患者中，早期MMAE与手术队列中较低的死亡率相关。这些发现支持进一步研究早期MMAE作为改善外科cSDH病例预后的潜在策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.