Chronic subdural hematoma treatment in oncological patients: middle meningeal artery embolization versus surgical drainage.

Objective: The aim of this study was to compare outcomes in cancer patients treated with middle meningeal artery embolization (MMAE) versus surgical treatment for chronic subdural hematomas (cSDHs), with outcome measures of requirement of rescue treatment and time to resumption of previously held systemic cancer therapy.

Methods: A retrospective cohort study was conducted that included a review of medical records of cancer patients with cSDH treated with MMAE or surgical drainage. Patients without adequate follow-up including radiological follow-up and patients who underwent dual therapy (i.e., MMAE plus surgery) were excluded. The primary outcome was the requirement for rescue treatment within 180 days, defined as surgical reintervention or repeat embolization due to hematoma progression or symptom recurrence. Secondary outcomes included the time to resumption of previously held systemic cancer therapy. Inverse probability of treatment weighting using covariate balancing propensity scores was used to adjust for baseline differences.

Results: A total of 110 patients were included. Of these patients, 54 received MMAE and 56 were treated with surgical drainage. No significant differences were found regarding baseline demographic features. Although patients in the surgery group had a higher incidence of headaches and dizziness preoperatively, no difference in preoperative motor deficits was found. The MMAE group had a higher incidence of clotting disturbances and thrombocytopenia. Within 180 days, 5.6% of the patients who underwent MMAE required rescue treatment, all performed through surgical drainage. In contrast, 30.4% of the surgically treated patients required rescue treatment that included surgery, MMAE, or a combination of both. A Poisson regression analysis for rescue treatment within 180 days demonstrated that patients treated with MMAE had an 87.5% lower incidence rate of rescue treatment compared with those who underwent surgical drainage (p = 0.001). Additionally, the surgery group received significantly more postoperative platelet transfusions (median of 6 units) when compared with 0 units in the MMAE group. Time to restart previously held chemotherapy was significantly shorter in the MMAE group (p = 0.005).

Conclusions: MMAE as a primary therapy for cSDH in cancer patients was associated with lower recurrence rates, earlier resumption of cancer therapy, reduction in platelet transfusion, and shorter hospitalizations compared with surgical drainage. These findings suggest that MMAE alone is safe and effective, and facilitates earlier resumption of chemotherapy in the oncology population.