Comparison of polyvinyl alcohol particles and tris-acryl gelatin microspheres for middle meningeal artery embolization in chronic subdural hematoma.

Abstract

Our study aimed to compare the outcome after middle meningeal artery (MMA) embolization with polyvinyl alcohol (PVA) particles and tris-acryl gelatin microspheres (TAGMs) in patients with chronic subdural hematoma (SDH). A retrospective and prospective observational study was performed on patients with chronic SDH who underwent MMA embolization, with or without surgical evacuation, using PVA particles (250-355 µm) or TAGMs (100-300 µm) between November 2020 and June 2024. The primary efficacy outcome was the absence of recurrence, defined as new onset or worsening of existing neurological symptoms, associated with a residual or recurrent SDH with hyperdense contents on computed tomography (CT) within 90 days. Procedure-related adverse events were noted. Ninety-six patients were included in the study (mean age, 67±11.7 (standard deviation (SD)) years; males, 86/96 (89.6%)). MMA embolization was done as an adjunct to surgery in 88/96 patients (91.7%) and as the primary treatment in 8/96 patients (8.3%). PVA particles were used in 46 patients, and TAGMs in 50 patients. The clinical recurrence rate was similar in the PVA group (3/46, 6.5%) and the TAGM group (3/50, 6%) (P>0.99). The incidence of post-procedure headache was significantly higher in the TAGM group (24/50, 48%) than in the PVA group (2/46, 4.4%) (P<0.001). The recurrence rate of chronic SDH is low after MMA embolization, irrespective of the type of particulate agent used for the embolization. The distal penetration of TAGMs does not provide an added advantage over PVA particles.