Comparison of adjunctive middle meningeal artery embolization using embosphere particles versus surgical drainage alone for the treatment of chronic subdural hematoma: A prospective study

Background

Middle meningeal artery embolization (MMAE) has emerged as a primary and adjunctive therapy for chronic subdural hematoma (CSDH) in addition to conventional treatment. However, there is a scarcity of data that explicitly compares the effectiveness of adjunctive MMAE to surgical drainage alone (SDA), as well as the use of Embosphere particles. The objective of this study was to assess the safety and efficacy of adjunctive MMAE in the treatment of symptomatic CSDH compared to SDA.

Methods

This prospective study included 43 patients with 52 CSDH sides, treated at a single institution between 2022 and 2023. The primary outcome was postoperative hematoma volume at 14, 30, 90, and 180 days after surgical drainage, which was analyzed using the generalized estimating equation. The secondary outcomes were the complications and recurrence/reoperation rate. Adjunctive MMAE was performed within 7 days following the surgery, utilizing Embosphere as the embolic material.

Results

The patients were assigned to either the adjunctive MMAE group (n = 20, 26 CSDH sides) or the SDA group (n = 23, 26 CSDH sides). The adjunctive MMAE group demonstrated a more significant reduction in hematoma volume (p = 0.007) and maximal hematoma thickness (p = 0.016) at all follow-up intervals. A trend towards lower recurrence and reoperation rates was observed with adjunctive MMAE; particularly, none of the patients in the adjunctive MMAE group experienced a recurrence of CSDH, compared to 19.2 % in the SDA group (p = 0.051). One procedural-related complication (3.8 %) in the adjunctive MMAE group.

Conclusion

Our results suggested that adjunctive MMAE, compared to SDA, may enhance hematoma resolution and reduce the need for reoperation due to recurrence.