Embolization of the middle meningeal artery as a nonsurgical option for chronic subdural hematoma: a prospective matching study.

Objective: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. Middle meningeal artery embolization (MMAE) is a treatment option in addition or as an alternative to conservative or surgical therapy. The objective of this study was to investigate whether MMAE can be used as a primary treatment method in patients with CSDH without an acute indication for surgery, and as a therapeutic option instead of a reoperation in cases of recurrence after surgery.

Methods: Fifty-one patients with MMAE as the primary treatment method for CSDH or for cases of recurrence after surgical treatment were prospectively included. A retrospective matching with patients treated only surgically was performed using the criteria of age, gender, size and side of the CSDH, as well as anticoagulation therapy. In the follow-up, the frequency of rescue operations and complications and the resumption of anticoagulation treatment were analyzed.

Results: Eleven patients with MMAE and 14 controls underwent rescue surgery due to relevant worsening of symptoms (p = 0.638). None of the patients with MMAE experienced a complication, compared with 7 of the controls (p = 0.012). When anticoagulation treatment was resumed, there was a tendency in favor of MMAE (p = 0.058).

Conclusions: There is a tendency toward superiority of MMAE for CSDH in certain patients. However, uncertainties remain regarding the exact methodology and optimal indications, and further research will be needed.