Standalone Middle Meningeal Artery Embolization Versus Medical Management for Chronic Subdural Hematomas: A Multi-Institutional and Multinational Database Study.

Abstract

Middle meningeal artery embolization (MMAE) has emerged as a promising treatment option for patients with chronic subdural hematomas (cSDHs). This study compares outcomes in nonsurgical cSDH patients undergoing MMAE versus those receiving medical management alone. This multi-institutional, multinational, retrospective, propensity score-matched analysis utilized the TriNetX platform. Nonsurgical cSDH patients requiring inpatient management were identified using International Classification of Diseases, 10th Revision codes. Outcome measures included unplanned inpatient readmissions, the need for surgical evacuation, and mortality within six months of diagnosis. Among 253,108 cSDH patients, 163,465 required inpatient management, with 769 patients undergoing MMAE and 162,696 receiving medical management alone. The MMAE cohort had significantly lower odds of requiring subsequent surgery, both before and after propensity score matching (odds ratio: 0.472, 95% confidence interval: 0.235-0.946, P = 0.031). Although MMAE patients had lower mortality (12.1%) compared to those receiving medical management (15.0%) before matching, this difference was not statistically significant after matching (odds ratio: 0.807, 95% confidence interval: 0.601-1.084, P = 0.154). No difference was observed in unplanned readmissions. Nonsurgical cSDH patients who received stand-alone MMAE had lower odds of requiring subsequent surgery, lower mortality rates (though not statistically significant), and similar odds of unplanned inpatient readmissions compared to those treated with medical management alone.